Mesothelioma Diagnosis

Diagnosing mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient's medical history. A history of exposure to asbestos may increase clinical suspicion for mesothelioma. A physical examination is performed, followed by chest X-ray and often lung function tests. The X-ray may reveal pleural thickening commonly seen after asbestos exposure and increases suspicion of mesothelioma. A CT (or CAT) scan or an MRI is usually performed. If a large amount of fluid is present, abnormal cells may be detected by cytology if this fluid is aspirated with a syringe. For pleural fluid this is done by a pleural tap or chest drain, in ascites with an paracentesis or ascitic drain and in a pericardial effusion with pericardiocentesis. While absence of malignant cells on cytology does not completely exclude mesothelioma, it makes it much more unlikely, especially if an alternative diagnosis can be made (e.g. tuberculosis, heart failure).

If cytology is positive or a plaque is regarded as suspicious, a biopsy is needed to confirm a diagnosis of mesothelioma. A doctor removes a sample of tissue for examination under a microscope by a pathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples.

If the cancer is in the abdomen, the doctor may perform a laparoscopy. To obtain tissue for examination, the doctor makes a small opening in the abdomen and inserts a special instrument into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary.

Doctors have begun testing the Mesomark assay which measures levels of soluble mesothelin-related proteins (SMRPs) released by diseased mesothelioma cells. The procedure could diagnose mesothelioma earlier than conventional methods thus improving the survival prospects for patients.^[3]

Typical immunohistochemistry results

Positive	Negative
EMA (epithelial membrane antigen) in a membranous distribution	CEA (carcinoembryonic antigen)
WT1 (Wilms' tumour 1)	B72.3
Calretinin	MOC-3 1
Mesothelin-1	CD15
Cytokeratin 5/6	Ber-EP4
HBME-1 (human mesothelial cell 1)	TTF-1 (thyroid transcription factor-1)

Mesothelioma Signs and symptoms

Signs and symptoms of mesothelioma vary depending on where the cancer occurs.

Pleural mesothelioma signs and symptoms may include:

* Shortness of breath
* Painful breathing
* Chest pain under the rib cage
* Unusual lumps of tissue under the skin on your chest
* Unexplained weight loss
* Dry (nonproductive) cough

Peritoneal mesothelioma signs and symptoms may include:

* Abdominal pain
* Abdominal swelling
* A change in your bowel habits, such as more frequent diarrhea or constipation
* Lumps of tissue in the abdomen
* Unexplained weight loss

Signs and symptoms of pericardial mesothelioma and mesothelioma of the tunica vaginalis are unclear. These forms are so rare that not much information is available. Mesothelioma of the tunica vaginalis may be first detected as a mass on a testicle. Pericardial mesothelioma signs and symptoms may include difficulty breathing and fever.

Signs and symptoms of mesothelioma that has spread to other parts of the body include:

* Pain in the area where cancer has spread
* Difficulty swallowing
* Swelling in the neck and face

Mesothelioma (Causes)

What are the main causes of mesothelioma?

Mesothelioma is most predominantly caused by asbestos exposure. Asbestos fibers that are inhaled through the mouth and nose may eventually become embedded in the lining of the lungs, causing damage and resulting in lung cancer or asbestosis (scar tissue formation in the lungs). It has also been found that swallowing asbestos fibers could contribute to a form of mesothelioma originating in the abdomen called peritoneal mesothelioma.

Mesothelioma generally results from occupational exposure but there are instances of environmental exposure to asbestos that can cause the disease. Oftentimes second hand exposure of a family member to an asbestos workers dirty work clothes can result in that family member developing mesothelioma.

Asbestos insulation workers appear to have the highest death rate. One study reports that almost six percent of asbestos workers fall victim to mesothelioma and asbestos insulation workers are over 300 times more likely to die from mesothelioma than the general public.

Mesothelioma (Risk Factors)

What are the risk factors for malignant mesothelioma?

There are several risk factors that increase the likelihood that a person will develop mesothelioma. The primary risk factor is asbestos exposure. Exposure to this very harmful substance can significantly enhance the chances of contracting the disease. Other secondary factors include exposure to radiation, zeolite, simian virus 40 (SV40) and tobacco. We discuss each of these risk factors in more detail below.

Asbestos

Exposure to asbestos is the leading risk factor associated with mesothelioma. Asbestos is an insulating material comprised of magnesium-silicate mineral fibers. It was favored by builders and contractors for many years for its low heat conductivity and resistance to melting and burning. Since researchers have identified more and more links between mesothelioma and exposure to asbestos, the material is now less widely used. Prior to this discovery, however, millions of Americans have experienced serious exposure to this harmful substance.

Over 700,000 schools and buildings in the United States today contain asbestos insulation as reported by the US Environmental Protection Agency. Asbestos exposure doesn’t stop there, however. Asbestos is often found in ship yards, manufacturing facilities, railway facilities and construction sites. Blue collar workers are at the highest risk for developing mesothelioma due to occupational exposure and include those who work in mines, factories, shipyards, construction sites, railroads and for insulation manufacturers and gas mask manufacturers. The occupations most widely affected are miners, factory workers, railroad workers, ship builders and construction workers - especially those who install asbestos containing insulation. Sometimes family members related to the workers receive second hand exposure to asbestos from the dust and fibers that were brought home on the workers clothes and also become at risk for contracting mesothelioma.

Serpentine fibers and amphiboles are the 2 primary types of asbestos used. Chrysotile is a form of serpentine fiber and the most frequently used. These fibers tend to be curly and flexible. Amphibole fibers, however, are generally straight and thin and usually comprise one of five types: crocidolite, amosite, anthrophylite, tremolite, and actinolyte. The crocidolite type of Amphiboles is thought to be the leading contributor to cancer caused by asbestos. Serpentine fibers are dangerous as well, however, and have also been linked to mesothelioma.

Some research points to the fact that inhaled asbestos fibers cause a physical irritation resulting in cancer rather than the cancer being caused by a reaction that is more chemical in nature. As fibers are inhaled through the mouth and nose they are cleared from the body by adhering to mucus in the nose, throat and airways and then get expelled by coughing or swallowing. The Amphibole fibers (long and thin) do not clear as easily and it is therefore thought that they can embed into the lining of the lungs and chest and result in mesothelioma.

Asbestosis (scar tissue in the lungs) or lung cancer can also be caused by the inhalation of asbestos fibers. In fact, people exposed to asbestos are seven times more likely to develop lung cancer over the general public. Workers who sustain high levels of asbestos exposure are more likely to die from asbestosis, lung cancer or mesothelioma than any other disease. It is also believed that the action of coughing up and swallowing asbestos could contribute to a form of mesothelioma originating in the abdomen called peritoneal mesothelioma. Mesothelioma has been found to exist in other organs of the body as well such as the larynx, pancreas and colon, but those instances are extremely limited compared to lung cancer incidents.

The chance of developing mesothelioma is in direct proportion to the duration and amount of asbestos exposure that an individual sustains. Those who are exposed to high levels of asbestos at a young age, for long periods of time have a greater risk of being diagnosed with mesothelioma than those who have short, low level exposure. Another important consideration is that Mesothelioma can take a long time to manifest. Often, twenty to forty years can elapse from the time of exposure to diagnosis. Genetic factors can also play a role which explains why not everyone exposed to asbestos develops and asbestos related disease.

Radiation
Thorium dioxide (Thorotrast), a substance used in x-ray tests in the past has reported links to pleural mesothelioma and peritoneal mesothelioma. The use of Thorotrast has been discontinued for many years due to this discovery.

Zeolite
Some mesothelioma cases in the Anatoli region within Turkey have been linked to Zeolite, a silica based mineral with chemical properties similar to asbestos found in the soil there.

Simian Virus 40 (SV40)
Some scientists have found the simian virus 40 (SV30) in mesothelioma cells from humans and have been able to create mesothelioma in animals with the virus. The relationship between this virus and mesothelioma is still unclear, however, and further research is being conducted to gain clarity on this potential link.

Tobacco
Smoking alone is not linked to mesothelioma, but smokers who are exposed to asbestos have a much higher chance of developing lung cancer (as much as fifty to ninety percent higher). Research indicates that lung cancer is the leading cause of death among asbestos workers.

Mesothelioma

What are the different types of mesothelioma?

Malignant Mesothelioma

Malignant mesothelioma is an uncommon form of cancer and of all asbestos related diseases, the most serious. The symptoms associated with the disease make it difficult for doctors to diagnose. Often, by the time that a proper diagnosis is made, the disease has progressed to a point where patients do not respond well to treatment therapy. Malignant mesothelioma is caused almost exclusively by the inhalation of airborne asbestos particles. Another unique factor associated with the disease is that there can be a long latency period between the time an individual is exposed to asbestos and the actual manifestation of the disease in the form of malignant mesothelioma.

Pleural Mesothelioma – affects the chest and lungs

Malignant pleural mesothelioma often originates within the chest cavity and can, at times, involve the lung. This particular form of mesothelioma can metastasize to numerous organs in the body – even the brain - and tends to do so more frequently than not.

Pleural mesothelioma is not always easily detectable. Frequently, in the early stages of the disease, symptoms may be mild. Patients usually report pain in one area of the chest that never seems to go away, weight loss and fever. Occasionally, other symptoms are more severe and include problems with breathing due to fluid build up in the chest. A CT Scan of the chest area has proven to be the best test for identifying how far along the disease has progressed.

Frequently serum markers are used to diagnose of various forms of cancer. Mesothelioma cannot be diagnosed using this method as no serum markers currently exist. If high levels of hyaluronic acid are present it may be possible to distinguish mesothelioma from other types of cancer or to determine the effectiveness of a treatment protocol.

The survival rate for patients diagnosed with pleural mesothelioma typically is not high. Patients typically do not live beyond seventeen months from the onset of symptoms. Only 8% of those diagnosed with mesothelioma will live three to five years from the onset of symptoms.

Peritoneal Mesothelioma – affects the abdomen

Peritoneal mesothelioma originates in the abdomen and will frequently spread to other organs in area including the liver, spleen or bowel. Severe abdominal pain is the most common complaint that patients present to their doctor. There may also be a discomfort level with fluid build up in the abdomen as well. Other symptoms of peritoneal mesothelioma may include difficult bowel movements, nausea and vomiting, fever and swollen feet.

The survival rate is even worse for those diagnosed with peritoneal mesothelioma will patients typically surviving only ten months from time that they first started experiencing the symptoms noted above.

Pericardial Mesothelioma – affects the heart

Pericardial mesothelioma is the least common form of mesothelioma. Pericardial mesothelioma, as the name suggests, involves the heart. This rare type of mesothelioma invades the pericardium, the sac that surrounds the heart. As the cancer progresses, the heart is not able to deliver oxygen as efficiently to the body causing further decline in health at an increasingly rapid rate. The symptoms most commonly associated with pericardial mesothelioma mimic those of a heart attack: nausea, pain in the chest and shortness of breath.

Benign Mesothelioma – affects the peritoneum

Cystic mesothelioma primarily affects women of younger age and affects the peritoneum. This type of mesothelioma is not frequently diagnosed and is also not a malignant form of the disease. It is, however, extremely difficult to identify and requires specialized microscopes and immunologic techniques to aid in diagnosis.

Mesothelioma in Uncommon Sites

A form of cardiac cancer that is rarely seen involves the pericardium. Tumors associated with this type of mesothelioma are not easily detectable and patients presented with this diagnosis tend to have a very low survival rate. There have also been reports of mesothelioma involving ovaries in women and the scrotum in men. Treatment for all of these rare forms of mesothelioma will vary depending on what stage a patient has progressed to but in most all cases the projected outcome is not favorable.

Sodium: Are you getting too much?

You've been trying to eat less sodium — just a pinch of table salt on your baked potato and a dash to your scrambled eggs.

But a pinch and a dash can quickly add up to unhealthy levels of sodium, especially when many foods already contain more than enough sodium. About 11 percent of the sodium in the average U.S. diet comes from adding salt or other sodium-containing condiments to foods while cooking or eating. But the majority of the sodium — 77 percent — comes from eating prepared or processed foods that contain the mineral. So even though you may limit the amount of salt you add to food, the food itself may already be high in sodium.

Are you getting too much? Here's where sodium sneaks into your diet and ways you can shake the habit.

Sodium: Essential in small amounts

Your body needs some sodium to function properly. Sodium:

• Helps maintain the right balance of fluids in your body
• Helps transmit nerve impulses
• Influences the contraction and relaxation of muscles

Your kidneys regulate the amount of sodium kept in your body. When sodium levels are low, your kidneys conserve sodium. When levels are high, they excrete the excess amount in urine.

If your kidneys can't eliminate enough sodium, the sodium starts to accumulate in your blood. Because sodium attracts and holds water, your blood volume increases. Increased blood volume, in turn, makes your heart work harder to move more blood through your blood vessels, increasing pressure in your arteries. Certain diseases such as congestive heart failure, cirrhosis and chronic kidney disease can lead to an inability to regulate sodium.

Some people are more sensitive to the effects of sodium than are others. People who are sodium sensitive retain sodium more easily, leading to excess fluid retention and increased blood pressure. If you're in that group, extra sodium in your diet increases your chance of developing high blood pressure, a condition that can lead to cardiovascular and kidney diseases.

How much sodium do you need?

Various organizations, including the National Academy of Sciences' Institute of Medicine, have published recommendations for daily sodium intake. Most recommend between 1,500 and 2,400 milligrams (mg) a day for healthy adults. A lower sodium intake has a more beneficial effect on blood pressure.

If you are older than 50, are black or have a health condition such as high blood pressure, chronic kidney disease or diabetes, you may be more sensitive to the blood pressure raising effects of sodium. As a result, aim for a sodium intake at the low end of the range recommended for healthy adults. Talk to your doctor about the sodium limit that's best for you.

Three main sources of sodium

The average U.S. diet has three main sources of sodium:

• Processed and prepared foods. Most sodium in a person's diet comes from eating processed and prepared foods, such as canned vegetables, soups, luncheon meats and frozen foods. Food manufacturers use salt or other sodium-containing compounds to preserve food and to improve the taste and texture of food.
• Sodium-containing condiments. One teaspoon of table salt has 2,325 mg of sodium, and 1 tablespoon of soy sauce has 1,005 mg of sodium. Adding these or other sodium-laden condiments to your meals — either while cooking or at the table — raises the sodium count of food.
• Natural sources of sodium. Sodium naturally occurs in some foods, such as meat, poultry, dairy products and vegetables. For example, 1 cup of low-fat milk has about 110 mg of sodium.

Whether food comes by its sodium naturally or not, your daily intake can add up quickly when you tally the sodium from all of your meals and snacks. Here's an example of how easily sodium adds up:

Food	Amount of sodium
Breakfast
Scrambled eggs, 2 large	342 mg
Bacon, 1 slice	192 mg
Whole-wheat bread, 1 slice	148 mg
Butter, 2 teaspoons	54 mg
Total sodium for meal	736 mg
Lunch
Whole-wheat bread, 2 slices	296 mg
Ham, luncheon meat, 1 slice	350 mg
Mayonnaise, 1 tablespoon	105 mg
Dill pickle, 1 spear	385 mg
Pretzels, 1 ounce	486 mg
Orange, 1 large	0 mg
Total sodium for meal	1,622 mg
Dinner
Spaghetti noodles, 1 cup	179 mg
Spaghetti sauce, 1/2 cup	601 mg
Parmesan cheese, 1 tablespoon	76 mg
Green beans, canned, 1/2 cup	177 mg
Garlic bread, 1 slice	200 mg
Total sodium for meal	1,233 mg
Total sodium for the day	3,591 mg

Source: Department of Agriculture, Nutrient Data Laboratory, 2005

Be a savvy shopper: Find the sodium

Taste alone may not tell you which foods are high in sodium. For example, you may not think a bagel tastes salty, but a 4-inch oat-bran bagel has 451 mg of sodium.

So how do you identify foods high in sodium? The best way to determine sodium content is to read food labels. The Nutrition Facts label tells you how much sodium is in each serving. It also lists whether salt or sodium-containing compounds are ingredients. Examples of these compounds include:

• Monosodium glutamate (MSG)
• Baking soda
• Baking powder
• Disodium phosphate
• Sodium alginate
• Sodium nitrate or nitrite

How to cut your sodium intake

You may or may not be particularly sensitive to the effects of sodium. And because there's no way to know who might develop high blood pressure as a result of a high-sodium diet, choose and prepare foods with less sodium.

You can control your sodium intake several ways:

• Eat more fresh foods and fewer processed foods. Most fresh fruits and vegetables are naturally low in sodium. Also, fresh meat is lower in sodium than luncheon meat, bacon, hot dogs, sausage and ham are.
• Opt for low-sodium products. If you do buy processed foods, select those that have reduced sodium.
• Remove salt from recipes whenever possible. You can leave out the salt in many recipes, including casseroles, stews and other main dishes. Baked goods are an exception. Leaving out the salt could affect the quality as well as the taste of the food.
• Limit your use of sodium-laden condiments. Salad dressings, sauces, dips, ketchup, mustard and relish all contain sodium.
• Use herbs, spices and other flavorings to enhance foods. Learn how to use fresh or dried herbs, spices, zest from citrus fruit and fruit juices to jazz up your meals.
• Use salt substitutes wisely. Some salt substitutes or light salts contain a mixture of table salt (sodium chloride) and other compounds. To achieve that familiar salty taste, you may use too much of the substitute and actually not reduce your sodium intake. In addition, many salt substitutes contain potassium chloride. Though dietary potassium can lessen some of the harm of excess sodium, too much supplemental potassium can be harmful if you have kidney problems or if you're taking medications for congestive heart failure or high blood pressure that cause potassium retention.

Your taste for salt is acquired, so it's reversible. To unlearn this salty savoring, decrease your use of salt gradually and your taste buds will adjust. Most people find that after a few weeks of cutting their salt intake, they no longer miss it. Start by using no more than 1/4 teaspoon of added salt daily, then gradually reduce to no salt add-ons. As you use less salt, your preference for it lessens, allowing you to enjoy the taste of food itself.

© 1998-2007 Mayo Foundation for Medical Education and Research (MFMER).

Muscle Building Supplements - How To Choose The Right Ones

By : Mike Singh

If you just walked into the health store to purchase muscle building supplements, you are probably lost, confused and being pushed a dozen products by the salesman. But, how do you know which supplements are the right products for your goals? There are various levels of muscle building supplements and some may not be right for you. But, there are a handful that are excellent choices for anyone looking to build muscle.

Remember, you don't always need these supplements to build muscle, but these will definitely accelerate you towards your goals. They work as a tool to help you increase your potential for muscular development. They help in muscle growth, and quicker recovery times. Some important ingredients of muscle building supplements are:

Protein: The protein supplements are full of amino acids which are the building blocks for your muscles. Make sure that you include a supplement that takes into account proteins. You can take up to one to two grams of protein per pound of your weight. If you don't want to take them in a pill form, get the protein through shakes or even bars. Also, look for those that contain eggs, whey, soy or casein.

Creatine: The next important ingredient in the supplement you choose should be creatine. It will help to increase muscle mass by decreasing muscle fatigue and improving muscle recovery. It helps to increase something called ATP which is an energy source that will allow you to do more reps of higher weight. It is recommended that this should be taken in cycles e.g. four weeks on it then two weeks off of it.

Micro-nutrients - multivitamins and multiminerals: Many people mistakenly assume that they are getting enough vitamins and minerals through their normal diet. Unfortunately, this is not the case. We would have to consume extremely large quantities of food to get the recommended daily intake. An easier approach would be to supplement our diet with a good quality multi-vitamin/multi-mineral supplement. If you do not have one specific mineral in your diet, this can slow down your ability to develop muscles or improve your health.

Author Resource:- Mike Singh is the publisher of http://www.1-stop-fitness.com/ On his website he provides articles about womens health and fitness and adjustable weight benches.