The mystery of mesothelioma

Janelle’s Journey, Part I

Elizabeth Gist

Janelle Bedel looks just like any other 31-year-old mother. Her face lights up when she talks about her little boy, Carson. Her home is filled with pictures of them and evidence that a 4-year-old inhabits the home is present everywhere.

But unlike every other mother of a 4-year-old, Janelle was just handed a grim diagnosis. Her face is pained as she recounts the harrowing road she has gone down in the last two months; pained because of the pain, and pained because she has to constantly think of what the diagnosis is not only doing to her body, but to her son and family as well.

Janelle was just diagnosed with stage 2 mesothelioma.

This is the first installment of Janelle’s Journey, which will explain just what mesothelioma is, how it is contracted, and other related information. The Rushville Republican will follow Janelle as she begins chemotherapy, as her family hosts a benefit in her honor, as she heads to New York for surgery, and as she holds on to the power of hope.

THE DISEASE

The National Cancer Institute states that: "Malignant mesothelioma, a rare form of cancer, is a disease in which cancer (malignant) cells are found in the sac lining the chest (the pleura), the lining of the abdominal cavity (the peritoneum) or the lining around the heart (the pericardium)."

Most people with malignant mesothelioma have worked on jobs where they breathed asbestos. Others have been exposed to asbestos in a household environment, often without knowing it.

There is a latency period of 20 to 50 years or more between initial exposure and development of the disease with the average being between 35 and 40 years. Rare instances have been documented when the interval was less than 20 years.

The incidence of mesothelioma rises with the intensity and duration of exposure to asbestos. However, there are numerous cases of mesothelioma among people with very little occupational exposure or even household exposure.

There are cases of people getting mesothelioma 30 or 40 years after a summer job working construction, and cases of housewives or children being exposed from work clothing. Many people being diagnosed with mesothelioma now were exposed in the Navy many years ago, often unknowingly.

How Janelle contracted this form of cancer is a mystery. It is commonly due to being exposed to materials containing asbestos. Most insulation materials before the mid-1970s contained asbestos. Other materials, including insulation on pipes, boiler insulation, insulating cements, plasters and joint compounds that came in powder form and created a lot of dust before being completely mixed with water, fireproofing spray, firebrick and gunnite used for internal insulation of furnaces, boilers and other vessels, roof, floor and ceiling tiles, transite siding, and brakes and clutches.

Boilermakers, insulators, plumbers, plasterers and bricklayers are among tradesmen exposed to asbestos.

Since the early 1940s, millions of Americans have been exposed to asbestos in the course of their jobs in the construction trades and in military service. Although it is known that the risk to workers increases with heavier exposure and longer exposure times, asbestos-related illnesses have been found in individuals with only brief exposures. Because of the long latency period, no signs of illness may be apparent for 20 to 50 or more years.

Family members of workers heavily exposed to asbestos also face an increased risk of developing mesothelioma. This is most often the result of asbestos dust being brought into the home on the shoes, clothing, skin, and hair of workers. This type of exposure is referred to as paraoccupational or household exposure.

It is important to remember that not everyone exposed to asbestos will develop diseases related to their exposure. In fact, many will experience no ill effects whatsoever. Asbestos that is bonded into finished products such as walls, tiles, and pipes poses no risk to health as long as these products are not damaged or disturbed in such a way that fibers are released into the air. It is when asbestos fibers are released and inhaled or digested that individuals are at risk for developing asbestos disease. Once these fibers work their way into body tissues, they may stay there indefinitely.

The early symptoms of mesothelioma are generally non-specific, and may lead to a delay in diagnosis. Sometimes resembling viral pneumonia, pleural mesothelioma patients may present with shortness of breath, chest pain and/or persistent cough; some patients show no symptoms at all.

A chest x-ray may show a build-up of fluid or pleural effusion (discussed below). The right lung is affected 60 percent of the time, with involvement of both lungs being seen in approximately 5 percent of patients at the time of diagnosis. Less common symptoms of pleural mesothelioma include fever, night sweats and weight loss.

Janelle experienced one of the most common symptoms of mesothelioma, which is a pleural effusion, or an accumulation of fluid between the parietal pleura (the pleura covering the chest wall and diaphragm) and the visceral pleura (the pleura covering the lungs). Both of these membranes are covered with mesothelial cells which, under normal conditions, produce a small amount of fluid that acts as a lubricant between the chest wall and the lung. Any excess fluid is absorbed by blood and lymph vessels maintaining a balance. When too much fluid forms, the result is an effusion.

As the volume of fluid increases, shortness of breath, known as "dyspnea", and sometimes pain, ranging from mild to stabbing, may occur. Some patients may experience a dry cough. When the doctor listens to the patient’s chest with a stethoscope, normal breath sounds are muted, and tapping on the chest will reveal dull rather than hollow sounds.

Diagnosis of pleural effusion is usually accomplished with a simple chest x-ray, although CT scans or ultrasound may also be used. A special x-ray technique, called a lateral decubitus film, may be used to detect smaller effusions or to enable the physician to estimate of the amount of fluid present. If the underlying cause of the effusion is readily apparent (such as in the case of severe congestive heart failure), sampling of the fluid may not be necessary, however, because pleural effusion may be symptomatic of a number of disease processes from benign to malignant, a fluid sample is generally taken. Diagnostic thoracentesis, in which cells are extracted from the pleural cavity, is commonly done when the possibility of mesothelioma exists, however, in up to 85% of cases, the fluid tests negative or inconclusive even though cancer is present. It is ultimately a needle biopsy of the pleura (lining of the lung) or an open surgical biopsy which confirms a mesothelioma diagnosis.

When testing has realized no diagnosis, and fluid continues to build or recur, doctors may recommend chest tube drainage and chemical pleurodesis. This was the case with Janelle’s form of the disease. Chemical pleurodesis is a technique in which a sclerosing agent is used to abrade the pleural surfaces producing an adhesion between the parietal and visceral pleurae. This will prevent further effusion by eliminating the pleural space. Talc appears to be the most effective agent for pleurodesis, with a success rate of nearly 95%. It is highly effective when administered by either poudrage or slurry. Poudrage is the most widely used method of instilling talc into the pleural space. Before spraying the talc, the medical team removes all pleural fluid to completely collapse the lung. After the talc is administered, they inspect the pleural cavity to be sure the talc has been evenly distributed over the pleural surface.

A diagnosis of mesothelioma is most often obtained with careful assessment of clinical and radiological findings in addition to a confirming tissue biopsy. A review of the patient's medical history, including history of asbestos exposure is taken, followed by a complete physical examination, x-rays of the chest or abdomen, and lung function tests.

A CT scan or MRI may also be done at this time. If any of these preliminary tests prove suspicious for mesothelioma; a biopsy is necessary to confirm this diagnosis.

Treatment options are often determined by the stage of mesothelioma a patient is in. There are three staging systems currently in use for pleural mesothelioma and each one measures somewhat different variables; peritoneal mesothelioma is not staged.

(Information regarding mesothelioma for this article came from www.mesotheliomaweb.org.)



Elizabeth Gist can be contacted at elizabeth.gist@rushvillerepublican.com or at (765) 932-3111 ext. 109. Add a comment to this story at www.rushvillerepublican.com.

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