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Friday, November 9, 2007

Clinical trials

A clinical trial is a research study to answer specific questions about vaccines or new therapies or new ways of using known treatments.Clinical Trials also called medical research and research studies] are used to determine whether new drugs or treatments are both safe and effective. Carefully conducted clinical trials are the fastest and safest way to find treatments that work. Leads for clinical trials usually come from researchers. Once researchers test new therapies or procedures in the laboratory [animal studies] and get promising results, they begin planning Phase I clinical trials [in humans].New therapies are tested on people only after laboratory and animal studies show promising results. Clinical Trials make it possible to apply the latest scientific and technological advances to patient care.When a new medical treatment is studied for the first time in humans, it is not known exactly how it will work. With any new treatment, there are possible risks as well as benefits.

Clinical trials help physicians discover the answers to the following questions

1. Is the treatment safe and effective?

2. Is the treatment potentially better than the treatments currently available?

3. What are the side effects of the treatment?

4. Does the treatment have any possible risks?

5. How well does the treatment work?

Phases of a Clinical Trial

Clinical Trials are conducted in Phases, each designed to find out specific information. Each new phase of a clinical trial builds on information from previous stages.

Clinical Trials of experimental drugs proceed through Four phases.

Phase I. In Phase I clinical trials, researchers tests a new drug or treatment in a small group of people [20-80] for the first time to evaluate its

· Safety

· Determine a safe dosage range

· Identify side effects

Phase II. In Phase II clinical trial, the study drug or treatment is given to a larger group of people [100-300] to see if it is EFFECTIVE. And to further evaluate its Safety.

Phase III. In Phase III studies, the study drug or treatment is given to large groups of people [1000-3000] to confirm its

· Effectiveness

· Monitor side effects

· Compare it to commonly used treatments

· Collect information that will allow the drug or treatment to be used safely.

Phase IV. Phase IV studies are done after the drug or treatment has been marketed. These studies continue testing the study drug or treatment to collect information about their effect in various populations and any side effect associated with its long term use.

The clinical trial participants are willing volunteers. There are several advantages as well as potential side effects from participating in a clinical trial.

Types of Clinical Trials

Some clinical trials are Blinded, Placebo controlled. The blinding can be single, double or triple blinding.

Informed Consent

Prior to getting involved in a clinical trial, informed consent is to be obtained from the volunteers. Informed consent means that as a patient, he is given all the available information so that he can understand what is involved in a specific clinical trial.The researchers conducting the clinical trial will explain the treatment schedules, including its possible benefits and risks. The informed consent process is ongoing till the end of the trial.Every clinical trial is designed to meet a specific set of research criteria. Clinical trials are often expensive and time consuming. But, the results are often scientifically sound and rewarding.

Types of Stem Cell Transplants: Overview

There are many types of stem cell transplants. This section defines each of the various types of transplants.

First, stem cell transplants are defined by by the source of the stem cells.
  • Bone marrow transplants are those that are obtained from the bone marrow. However, they are rarely performed today in myeloma because of the ability to collect stem cells from the peripheral blood (see below). Bone marrow transplants are sometimes used if insufficient numbers of stem cells can be obtained from the peripheral blood.

  • Peripheral blood stem cell (PBSC) transplants are obtained from the peripheral blood. PBSC transplants are now performed much more often than bone marrow transplants because they are easier to collect, they provide a more reliable number of stem cells, the procedure puts less strain on the donor's system, and the patient recovers more quickly

  • Cord blood transplants refer to transplants where the stem cells are obtained from umbilical cord blood. Historically they have not been used frequently due to limited numbers of stem cells that can be collected from each umbilical cord. Recently, however, exciting new data have been generated using multiple cord blood units from more than one donor.
Stem cell transplants are further categorized based on the donor who provides the stem cells.
  • Autologous stem cell transplants (autografts) refer to stem cells that are collected from an individual and given back to that same individual. Most stem cell transplants in myeloma are autologous transplants.

  • Allogeneic stem cell transplants (allografts) refer to stem cells that are taken from one person and given to another. Currently, these types of transplant are performed much less frequently in myeloma in the US and are usually performed in the context of clinical trials.

  • Syngeneic stem cell transplants refer to stem cells that are taken from an identical twin of the recipient. These types of transplants are quite rare
Lastly, there are also several types of transplants under investigation in clinical trials.
  • A tandem autologous transplant, also known as a double autologous transplant, requires the patient to undergo two autologous stem cell transplants within 6 months.

  • A mini (nonmyeloablative) allogeneic transplant involves the use of moderately high-dose chemotherapy in combination with an allogeneic stem cell transplant.

Stem cell transplantation

Stem cell transplantation, performed as support for high-dose chemotherapy, is a treatment option for many patients with myeloma. Studies have shown that this treatment improves both the response rate and survival in myeloma over that obtained with conventional chemotherapy.

The Center for International Blood and Marrow Transplant Research (CIBMTR) estimates that approximately 4,700 stem cell transplants of various types were performed in patients with myeloma in North America in 2003 (CIBMTR, 2005).*

*The data presented here are preliminary and were obtained from the Statistical Center of the Center for International Blood and Marrow Transplant Research (CIBMTR). The analysis has not been reviewed or approved by the Advisory or Scientific Committee of the CIBMTR.
What It Is
A stem cell transplant is a procedure that is used in conjunction with high-dose chemotherapy, which is frequently more effective than conventional chemotherapy in destroying myeloma cells. Because high-dose chemotherapy also destroys normal blood-producing stem cells in the bone marrow, these cells must be replaced in order to restore blood cell production.

The first step in the process of stem cell transplantation is the collection of stem cells from a patient or a donor. When a patient's own stem cells are used, they are frozen and stored until needed. Stem cells can be collected from a donor when they are needed. The patient then receives high-dose chemotherapy and the stem cells are infused into the patient's bloodstream. The stem cells travel to the bone marrow and begin to produce new blood cells, replacing the normal cells lost during high-dose chemotherapy.

High-dose chemotherapy and stem cell transplantation are typically performed following several cycles of conventional chemotherapy (also known as induction therapy). Induction therapy is performed first in order to reduce the tumor burden.

Lineage

To ensure self-renewal, stem cells undergo two types of cell division (see Stem cell division and differentiation diagram). Symmetric division gives rise to two identical daughter cells both endowed with stem cell properties. Asymmetric division, on the other hand, produces only one stem cell and a progenitor cell with limited self-renewal potential. Progenitors can go through several rounds of cell division before terminally differentiating into a mature cell. It is possible that the molecular distinction between symmetric and asymmetric divisions lies in differential segregation of cell membrane proteins (such as receptors) between the daughter cells.[21]

An alternative theory is that stem cells remain undifferentiated due to environmental cues in their particular niche. Stem cells differentiate when they leave that niche or no longer receive those signals. Studies in Drosophila germarium have identified the signals dpp and adherins junctions that prevent germarium stem cells from differentiating[22][23].

The signals that lead to reprogramming of cells to an embryonic-like state are also being investigated. These signal pathways include several transcription factors including the oncogene c-Myc. Initial studies indicate that transformation of mice cells with a combination of these anti-differentiation signals can reverse differentiation and may allow adult cells to become pluripotent.[24] However, the need to transform these cells with an oncogene may prevent the use of this approach in therapy.

Stem Cells

Stem cells are primal cells found in all multi-cellular organisms. They retain the ability to renew themselves through mitotic cell division and can differentiate into a diverse range of specialized cell types. Research in the human stem cell field grew out of findings by Canadian scientists Ernest A. McCulloch and James E. Till in the 1960s.[1][2]

The two broad categories of mammalian stem cells are: embryonic stem cells, derived from blastocysts and adult stem cells, which are found in adult tissues. In a developing embryo, stem cells can differentiate into all of the specialized embryonic tissues. In adult organisms, stem cells and progenitor cells act as a repair system for the body, replenishing specialized cells.

As stem cells can be grown and transformed into specialized cells with characteristics consistent with cells of various tissues such as muscles or nerves through cell culture, their use in medical therapies has been proposed. In particular, embryonic cell lines, autologous embryonic stem cells generated through therapeutic cloning, and highly plastic adult stem cells from the umbilical cord blood or bone marrow are touted as promising candidates.[3]

Stem Cell Research

Stem cells are primal cells found in all multi-cellular organisms. They retain the ability to renew themselves through mitotic cell division and can differentiate into a diverse range of specialized cell types. Research in the human stem cell field grew out of findings by Canadian scientists Ernest A. McCulloch and James E.

The three broad categories of mammalian stem cells are: embryonic stem cells, derived from blastocysts, adult stem cells, which are found in adult tissues, and cord blood stem cells, which are found in the umbilical cord. In a developing embryo, stem cells can differentiate into all of the specialized embryonic tissues. In adult organisms, stem cells and progenitor cells act as a repair system for the body, replenishing specialized cells.

As stem cells can be grown and transformed into specialized cells with characteristics consistent with cells of various tissues such as muscles or nerves through cell culture their use in medical therapies has been proposed. In particular, embryonic cell lines, autologous embryonic stem cells generated through therapeutic cloning, and highly plastic adult stem cells from the umbilical cord blood or bone marrow are touted as promising candidates

Potency definitions

Pluripotent, embryonic stem cells originate as inner mass cells with in a blastocyst. The stem cells can become any tissue in the body, excluding a placenta. Only the morula's cells are totipotent, able to become all tissues and a placenta.

Potency specifies the differentiation potential (the potential to differentiate into different cell types) of the stem cell.

Totipotent stem cells are produced from the fusion of an egg and sperm cell. Cells produced by the first few divisions of the fertilized egg are also totipotent. These cells can differentiate into embryonic and extraembryonic cell types.

Pluripotent stem cells are the descendants of totipotent cells and can differentiate into cells derived from any of the three germ layers.

Multipotent stem cells can produce only cells of a closely related family of cells (e.g. hematopoietic stem cells differentiate into red blood cells, white blood cells, platelets, etc.).

Unipotent cells can produce only one cell type, but have the property of self-renewal which distinguishes them from non-stem cells.

Stem cell properties

Defining properties

The rigorous definition of a stem cell requires that it possesses two properties:
Self-renewal - the ability to go through numerous cycles of cell division while maintaining the undifferentiated state.


Unlimited potency - the capacity to differentiate into any mature cell type. In a strict sense, this requires stem cells to be either totipotent or pluripotent, although some multipotent and/or unipotent progenitor cells are sometimes referred to as stem cells.


These properties can be illustrated in vitro, using methods such as clonogenic assays, where the progeny of single cell is characterized. However, in vitro culture conditions can alter the behavior of cells, making it unclear whether the cells will behave in a similar manner in vio. Considerable debate exists whether some proposed adult cell populations are truly stem cells.

Adult stem cells

Stem cell division and differentiation. A - stem cell; B - progenitor cell; C - differentiated cell; 1 - symmetric stem cell division; 2 - asymmetric stem cell division; 3 - progenitor division; 4 - terminal differentiation

The term Adult stem cell refers to any cell which is found in a developed organism that has two properties: the ability to divide and create another cell like itself and also divide and create a cell more differentiated than itself. Also known as somatic (from Greek Σωματικóς, of the body) stem cells, they can be found in children, as well as adults. Pluripotent adult stem cells are rare and generally small in number but can be found in a number of tissues including umbilical cord blood.

Most adult stem cells are lineage restricted (multipotent and are generally referred to by their tissue origin (mesenchymal stem cell, adipose-derived stem cell, endothelial stem cell
A great deal of adult stem cell research has focused on clarifying their capacity to divide or self-renew indefinitely and their differentiation potential.In mice, pluripotent stem cells can be directly generated from adult fibroblast cultures.

While embryonic stem cell potential remains untested, adult stem cell treatments have been used for many years to successfully treat leukemia and related bone/blood cancers through bone marrow transplants. The use of adult stem cells in research and therapy is not as controversial as embryonic stem cels, because the production of adult stem cells does not require the destruction of an embryo. Consequently, more US government funding is being provided for adult stem cell research

Embryonic stem cells

Embryonic stem cell lines (ES cell lines) are cultures of cells derived from the epiblast tissue of the inner cell mass (ICM) of a blastocyst or earlier morula stage embryos A blastocyst is an early stage embryo - approximately 4 to 5 days old in humans and consisting of 50-150 cells. ES cells are pluripotent, and give rise during development to all derivatives of the three primary germ layers: ectoderm, endoderm and mesoderm. In other words, they can develop into each of the more than 200 cell types of the adult body when given sufficient and necessary stimulation for a specific cell type. They do not contribute to the extra-embryonic membranes or the placenta.

Nearly all research to date has taken place using mouse embryonic stem cells (mES) or human embryonic stem cells (hES). Both have the essential stem cell characteristics, yet they require very different environments in order to maintain an undifferentiated state. Mouse ES cells are grown on a layer of gelatin and require the presence of Leukemia Inhibitory Factor (LIF). Human ES cells are grown on a feeder layer of mouse embryonic fibroblasts (MEF's) and require the presence of basic Fibroblast Growth Factor (bFGF or FGF-2).Without optimal culture conditions or genetic manipulation embryonic stem cells will rapidly differentiate.

A human embryonic stem cell is also defined by the presence of several transcription factors and cell surface proteins. The transcription factors Oct-4, Nanog, and Sox2 form the core regulatory network which ensures the suppression of genes that lead to differentiation and the maintenance of pluripotency.The cell surface proteins most commonly used to identify hES cells are the glycolipids SSEA3 and SSEA4 and the keratan sulfate antigens Tra-1-60 and Tra-1-81. The molecular definition of a stem cell includes many more proteins and continues to be a topic of research.


After 20 years of research, there are no approved treatments or human trials using embryonic stem cells. Their tendency to produce tumors and malignant carcinomas, cause transplant rejection, and form the wrong kinds of cells are just a few of the hurdles that embryonic stem cell researchers still face. Many nations currently have moratoria on either ES cell research or the production of new ES cell lines. Because of their combined abilities of unlimited expansion and pluripotency, embryonic stem cells remain a theoretically potential source for regenerative medicine and tissue replacement after injury or disease.

Controversy surrounding stem cell research

There exists a widespread controversy over stem cell research that emanates from the techniques used in the creation and usage of stem cells. Human embryonic stem cell research is particularly controversial because, with the present state of technology, starting a stem cell line requires the destruction of a human embryo and/or therapeutic cloning. However, recently, it has been shown that embryonic stem cell lines can be generated without destroying embryos using a single-cell biopsy method similar to preimplantation genetic diagnosis.

Opponents of the research argue that this practice is a slippery slope to reproductive cloning and tantamount to the instrumentalization of a human being. Contrarily, some medical researchers in the field argue that it is necessary to pursue embryonic stem cell research because the resultant technologies could have significant medical potential, and that excess embryos created for invitro fertilisation could be donated with consent and used for the research.

This in turn, conflicts with opponents in the pro-life movement, who argue that a human embryo is a human life and is therefore entitled to protection. The ensuing debate has prompted authorities around the world to seek regulatory frameworks and highlighted the fact that stem cell research represents a social and ethical challenge.


President Bush, twice in his tenure, vetoed the passage acts that would have eased restraints on federally funded embryonic stem cell research.

Treatments

Medical researchers believe that stem cell therapy has the potential to radically change the treatment of human disease. A number of adult stem cell therapies already exist, particularly bone marrow transplant that are used to treat leukemia In the future, medical researchers anticipate being able to use technologies derived from stem cell research to treat a wider variety of diseases including cancer, parkinson's disease, spinal cor injuries and muscle damage, amongst a number of other impairments and conditions.

However, there still exists a great deal of social and scientific uncertainty surrounding stem cell research, which could possibly be overcome through public debate and future research.
Stem cells, however, are already used extensively in research, and some scientists do not see cell therapy as the first goal of the research, but see the investigation of stem cells as a goal worthy in itself.

Stem Cell research key events

1960s - Joseph Altman and Gopal Das present evidence of adult neurogenesis, ongoing stem cell activity in the brain; their reports contradict Cajals "no new neurons" dogma and are largely ignored

1963 - McCulloch and Till illustrate the presence of self-renewing cells in mouse bone marrow

1968 - Bone marrow transplant between two siblings successfully treats SCID


1978 - Haematopoietic stem cells are discovered in human cord blood

1981 - Mouse embryonic stem cells are derived from the inner cell mass

1992 - Neural stem cells are cultured in vitro as neurospheres

1995 - U.S. President Bill Clinton signs into law the Dickey Amendment which prohibited
Federally appropriated funds to be used for research where human embryos would be either created or destroyed.

1997 - Leukemia is shown to originate from a haematopoietic stem cell, the first direct evidence for cancer stem cells

1998 - James Thomson and coworkers derive the first human embryonic stem cell line at the University of Wisconsin-Madison.

2000s - Several reports of adult stem cell plasticity are published

2001 - Scientists at Advanced Cell Technology clone first early (4 to 6 cell stage) human embryos for the purpose of generating embryonic stem cells

2003 - Dr. Songtao Shi of NIH discovers new source of adult stem cells in children's primary teeth

02 November, 2004 - California voters approve Proposition 71, which provides $3 billion in state funds over ten years to human embryonic stem cell research.

2001-2006 - U.S. President George W. Bush endorses the Congress in providing federal funding for embryonic stem cell research of approximately $100 million as well as $250 million dollars for research on adult and animal stem cells. He also enacts laws that restrict federally-funded stem cell research on embryonic stem cells to the already derived cell lines.

5 May, 2006 - Senator Rick Santorum introduces bill number S. 2754, into the U.S. Senate

18 July, 2006 - The U.S. Senate passes the Stem Cell Research Enhancement Act H.R. 8 and votes down Senator Santorum's S.2754.

19 July, 2006 - President George W. Bush vetoes H.R. 810 (Stem Cell Researc Enhancement Act, a bill that would have reversed the Clinton-era law which made it illegal for Federal money to be used for research where stem cells are derived from the destruction of an embryo.

August 2006 - Cell Journal publishes Kazutoshi Takahashi and Shinya Yamanaka, Induction of Pluripotent Stem Cells from Mouse Embryonic and Adult Fibroblast Cultures by Defined Factors

07 November, 2006 - The people of the U.S. state of Missouri passed Amendment 2, which allows usage of any stem cell research and therapy allowed under federal law, but prohibits human reproductive cloning.

07 January, 2007 - Scientists at Wake Forest University led by Dr. Anthony Atala and Harvard University report discovery of a new type of stem cell in amniotic fluid This may potentially provide an alternative to embryonic stem cells for use in research and therapy.

16 February, 2007 The California Institute for Regenerative Medicine became the biggest financial backer of human embryonic stem cell research in the United States when they awarded nearly $45 million in research grants.

06 June 2007 - Research reported by three different groups shows that normal skin cells can be reprogrammed to an embryonic state in mice.

Stem Cell research key events in other countries

2004-2005 - Korean researcher Hwang Woo-Suk claims to have created several human embryonic stem cell lines from unfertilised human oocytes. The lines were later shown to be fabricated.

2005 - Researchers at Kingston University in England claim to have discovered a third category of stem cell, dubbed cord-blood-derived embryoniclike stem cells (CBEs), derived from umbilical cord blood. The group claims these cells are able to differentiate into more types of tissue than adult stem cells.

18 June 2007 Scientist Shoukhrat Mitalipov reports the first successful creation of a primate stem cell line through somatic cell nuclear transfer

Angiogenesis

The Importance of Angiogenesis

The process by which new blood capillaries grow into a wound space after injury is known as angiogenesis. Wound angiogenesis is an important part of the proliferative phase of healing; in fact the term `granulation tissue' is used to describe the appearance of the prominent blood vessels of the initial connective tissue formed in the wound space.

Healing of any skin wound other than the most superficial cannot occur without angiogenesis. Not only does any damaged vasculature need to be repaired, but the increased local cell activity necessary for healing requires an increased supply of nutrients from the bloodstream. Moreover, the endothelial cells which form the lining of the blood vessels are important in themselves as organizers and regulators of healing.

It is interesting to note that angiogenesis also occurs in many other situations, including solid tumour growth and metastasis; rheumatoid arthritis; psoriasis; scleroderma; placental growth and embryo implantation; and three common causes of blindness - diabetic retinopathy, retrolental fibroplasia and neovascular glaucoma (in fact, diseases of the eye are almost always accompanied by vascularization. The process of wound angiogenesis has many features in common with tumour angiogenesis.

The Processes of Angiogenesis

Angiogenesis proceeds concurrently with the formation of new tissue (granulation tissue), which typically begins about 4 days post-wounding. It is stimulated by the chemicals (soluble factors) released by wounded tissue. The resulting processes are tightly regulated by cell-cell interactions, cell-ECM interactions and cell-soluble factor interactions.

A blood capillary consists of a hollow tube lined with endothelial cells. The outside of the tube is covered with a layer known as the basement membrane, a major component of which is collagen IV, and which also contains fibronectin and proteoglycans (compounds consisting mainly of polysaccharides but also containing protein).

Angiogenesis begins with degradation of the basement membrane, followed by migration of endothelial cells out of the vessel. These cells then form into a tube which `sprouts' from the old capillary and is extended further into the wound space as the cells behind the leading tip begin to proliferate. The tips of such tubes can branch and eventually join up with other sprouts to form a closed loop through which blood can flow.

The sprouting process begins again from these new vessels, until the wound space is permeated by a network of new capillaries. The cells of the capillaries first synthesize themselves a provisional covering containing fibronectin and proteoglycans, and finally form a true basement membrane.

As the granulation tissue matures, most of its vessels begin to disappear . The endothelial cells begin to undergo programmed cell death (apoptosis) and are removed from the tissue by scavenging macrophages.

Wednesday, November 7, 2007

What is mesothelioma?

What is mesothelioma?

Mesothelioma (pronounced mee-so-thee-lee-oma) is a cancer of the mesothelium. The mesothelium is a thin membrane that lines the chest and abdomen and surrounds the organs in these areas. The lining around the lungs is called the pleura and in the abdomen it is known as the peritoneum.

Mesotheliomas are uncommon cancers, although they are becoming more frequent. Currently, about 1800 people in the UK are diagnosed with mesothelioma each year.

Mesothelioma of the lining of the lungs (pleural mesothelioma) is much more common than mesothelioma in the peritoneum. For every person with peritoneal mesothelioma there will be about 12 people who have pleural mesothelioma.


What is Mesothelioma? Mesothelioma from the (Greek meso+ thelioma, tumor of middle lining tissue) is an uncommon cancer, originating from the cells which form the membrane lining the abdominal cavity (peritoneal membrane or peritoneum) which houses the intestines, or the chest (pleural membrane or pleura) cavity housing the heart and lungs, in which the cells making up those tissues begin to grow out of control.

Mesotheliomas most often are seen in older patients, more often men that have a history of occupational exposure to asbestos, although other causes such as radiation and certain viruses have occasionally been implicated. In a proportion of cases, no asbestos exposure can be identified.

Mesotheliomas involving the lung and pleura characteristically present as progressive shortness of breath due to the thickening of the lining membrane of the lung with gradual contraction of the breathing space; often, fluid accumulates in the lung spaces as well, further interfering with breathing, Mesotheliomas involving the abdominal cavity present with digestive symptoms, and abdominal swelling due to thickening of the lining membranes of the gut, and accumulation of large amounts of fluid in the abdomen.

How serious is it ? Mesotheliomas are serious and potentially life-threatening. Survival of patients with mesothelioma is usually short if effective treatment is not found, especially those with tumors that can be shown to be growing aggressively.breast cancer support,breast cancer,lung cancer,american cancer society,skin cancer,cancer,mesothelioma,asbestos Because mesotheliomas have usually spread throughout the pleural or peritoneal cavity before the diagnosis is made, complete surgical removal is only rarely possible. Moreover, mesotheliomas are not as sensitive to radiation therapy or chemotherapy as are many other tumors.

How are mesotheliomas diagnosed? In all cases, the diagnosis of mesothelioma must first be unquestionably established by biopsy of affected or suspicious tissues, and by definitive microscopic examination by a trained pathologist. Biopsy almost always requires an invasive procedure such as thoracoscopy and pleural biopsy, or laparotomy or laparoscopy, The removed tissues may be treated with special biological or chemical stains which are used to help the pathologist establish a firm diagnosis. The pathologist usually also comments upon the rate of growth and biological virulence of the tumor

Second, the tumor must be staged if possible by X-ray, CAT scan, MRI or other types of scans to clarify its location within the body, and to estimate the likelihood of effective curative or palliative therapy. Staging of mesothelioma by x-ray measurements, however, is difficult and often unreliable.

How are mesotheliomas treated? A treatment plan is devised depending upon the mesothelioma type, aggressiveness, primary location, and degree of local (rarely, distant) spread. The treatment of pleural mesothelioma is difficult.breast cancer support,breast cancer,lung cancer,american cancer society,skin cancer,cancer,mesothelioma,asbestos Treatment with surgery, radiation therapy or chemotherapy used alone or in combination may be proposed, depending upon the potential benefits and risks of each modality. Surgery is rarely used alone, but sometimes suffices when only a small pleural patch of mesothelioma is detected, thus allowing visually complete removal of the tumor. More often, mesotheliomas of the left or right pleural cavity cannot be completely removed without taking the entire lung (pneumonectomy) on the same side as well. In such cases, radiation therapy and/or chemotherapy is given postoperatively to help eradicate any residual mesothelioma that may have escaped the surgeon.

The treatment of peritoneal mesotheliomas is even more problematic; until recently no consistent treatment was available. At our institution, peritoneal mesotheliomas have been managed in the experimental setting with combined modality treatment consisting of extensive (usually not complete) debulking surgery, followed by intraperitoneal and systemic chemotherapy followed in turn by whole abdominal radiation therapy.

Because mesotheliomas now represent less than one percent of cancers and and are infrequently seen in the practice of most community oncologists, finding the correct treatment can be very difficult.breast cancer support,breast cancer,lung cancer,american cancer society,skin cancer,cancer,mesothelioma,asbestos Proper management of mesotheliomas often requires evaluation at larger tertiary hospitals or Comprehensive Cancer Centers by specialists in medical, surgical and radiation oncology with experience in all aspects of the clinical care of mesothelioma patients, including the newest experimental treatments.