ASBESTOS NEWS DAILY - MESOTHELIOMA DIAGNOSIS
Mesothelioma diagnosis begins with a review of the patient's medical history, including any history of asbestos exposure. The following procedures may be used to confirm a diagnosis and determine the stage of the Mesothelioma cancer and the appropriate treatments:
- Physical Examination - A complete physical examination may be performed, including x-rays of the chest or abdomen and lung function tests.
- Chest X-Ray - A chest x-ray can reveal fluid build up (pleural effusion) in either lung.
- CT Scan – A CT Scan is a series of detailed pictures taken of areas inside the body by an X-ray machine).
- MRI – MRI (Magnetic Resonance Imaging) is a powerful magnet linked to a computer that is used to take detailed pictures of areas inside the body. They are also more accurate than CT scans in assessing tumors and help determine if a patient is a surgical candidate.
- Fine-Needle Aspiration - A procedure, called fine-needle aspiration may be used to drain fluid from the lungs and abdominal cavities to relieve chest pain and shortness of breath.
- Biopsy - A tissue sample (biopsy) may be required if cancerous tumors are present. Tissue samples can be obtained via thoracoscopy for a lung tumor or via laparoscopy for an abdominal tumor.
- Bronchoscopy - A bronchoscopy is used for patients suspected of having Pleural Mesothelioma.
The average survival time after a Mesothelioma diagnosis is about one year. In some cases patients can live longer with early detection and aggressive treatment.
If you have worked with or have been exposed to asbestos, even if it was many years ago, you should inform your doctor and get screened for a Mesothelioma diagnosis even if you do not feel sick.
Diagnosed with Mesothelioma?
New test offers better diagnosis of asbestos cancer
26 Aug 09
CT scan showing a malignant mesothelioma (in the left of the image).
A new test can significantly improve diagnosis of the asbestos-related cancer mesothelioma, a joint team from theUniversity ofOxford and theOxford Centre for Respiratory Medicine at theJohnRadcliffeHospital has shown.
The test will now be added to the diagnostic options available to clinicians inOxford, when patients come to them with excess fluid in the space around the lungs.
A build up of fluid around the lungs is called a pleural effusion, and can lead to difficulties in breathing and chest pain. The excess fluid can be the result of a large variety of different causes – some malignant, some benign – but most mesothelioma patients present with a pleural effusion.
The standard diagnostic test to determine the cause involves taking a sample of the pleural fluid and looking for cancerous cells (cytology). While this is good at identifying other types of lung cancer, it is not a very sensitive test for mesothelioma. Many patients with suspected mesothelioma are then subjected to more invasive procedures before getting a more definitive diagnosis.
The team investigated whether a new test that measures the amount of a protein called mesothelin in the pleural fluid can aid diagnoses in patients with effusions of unknown causes.
Mesothelioma cells produce the protein mesothelin and release it into the fluid around the lungs, but it was not known whether measuring levels of mesothelin in the pleural fluid would provide an accurate diagnostic test.
The researchers collected 429 samples of pleural fluid from 209 patients. They analysed samples from 167 of these patients who were being investigated for the possible presence of malignant cancers.
The study, published in theAmerican Journal of Respiratory and Critical Care Medicine, found that testing for high levels of mesothelin was a simple and valuable addition to the usual cytology tests.
Improving the speed and certainty of a diagnosis will be very beneficial.
Professor Robert Davies
Levels of mesothelin in patients with mesothelioma are 6.9 times higher than those with other lung cancers, and 10.9 times higher than those with benign conditions.
Importantly, the test was found to be particularly useful where cytology gives an inconclusive or ‘suspicious’ result. One third of patients with mesothelioma fall into this category, so the pleural fluid mesothelin test may benefit up to 3,000 patients inWestern Europe each year. The test also substantially improves the confidence of a negative result for informing people they don’t have cancer.
'We looked at the value this test added to the existing method of diagnosis and we found it was pretty good actually,’ says Professor Robert Davies of the Oxford Biomedical Research Centre and the Oxford Centre for Respiratory Medicine. ‘It consistently gives a negative result in people without cancer and when the cytology is indeterminate, it is particularly helpful in identifying mesothelioma.’
Mesothelioma is a devastating and fatal cancer of the surface of the lungs that, in the vast majority of cases, is caused by exposure to asbestos. More than 2,150 people are diagnosed with mesothelioma in theUK each year, with many cases occurring among those that have worked in construction and engineering.
Asbestos is a mineral that was used an insulating material for its heat and fire resistance. But dust and fibres can be breathed in, which then work their way into the membranes that line the lungs. Cancer can develop many years later.
The number of cases of mesothelioma in theUK is expected to rise sharply over the next 20 years before eventually decreasing because of the heavy use of asbestos in industry from the end of the Second World War up until the mid 1970s.
'Because it’s a ghastly tumour, levels of anxiety among people waiting to find out whether they have mesothelioma is very high,’ says Professor Davies. ‘Improving the speed and certainty of a diagnosis will be very beneficial.’
Professor Davies emphasises that the close collaboration between the University and the John Radcliffe was essential to this work. The study was dependent on the patients coming into the Oxford Centre for Respiratory Medicine and the research capabilities of the University. This was enabled by the Oxford Biomedical Research Centre, a partnership between the University and the Oxford Radcliffe Hospitals NHS Trust with funding from the National Institute for Health Research.
Image credit: Tdvorak via Wikimedia Commons.
New Healthcare Plan Requires those Diagnosed with Mesothelioma to Seek Truth
Upon President Obama’s introduction of his new healthcare overhaul, opposing forces have manipulated its provisions and provided misinformation about the plan’s intentions.
Syracuse,New York 8/21/2009 02:01 PM GMT (FINDITT)
Obama’s new healthcare overhaul is causing uproar among Americans due to the misinformation and false claims that are being widely spread. Politics have created an ugly controversy that is overshadowing the truth behind this reform. Misconstruing language is being thrown between parties is causing the new healthcare reform plan to be portrayed as disingenuous and misconceiving.
One of the stronger statements being used by the Republican Party is the concept of “death panels”. These are described as entities created by the government to decide who receives treatment. Language such as this has sparked a fear in the population and those facing fatal illness are worried about their right to treatment options. A heavily disputed provision in the proposal is the government would pay for doctor consultations for those facing end-of-life issues. Those opposing to the healthcare overhaul have claimed that these consultations would be mandatory, though the actual proposal states that they would be voluntary.
This healthcare crisis will cause implications for those suffering from fatal illnesses, such as aggressive forms of cancer likemesothelioma. This type of cancer occurs in the mesothelium which is a thin layer of cells that line the body’s internal organs. Taking anywhere from 20 to 50 years to develop, this cancer is often found in older patients. Often called asbestos cancer, mesothelioma cancer is caused by the inhalation of dangerous asbestos fibers. The latency of the diagnosis is most haunting because of the similarity of the mesothelioma symptoms to those of the flu, pneumonia or bronchitis. Since these symptoms are commonly ignored for quite some time, the patient is often left with an intense treatment regime to try and stabilize the cancer as well as provide comfort and palliative care.
As the role of the federal government increased with the onset of the new healthcare proposal, cancer treatment regimes will have to be given a second look. The lack of stability within our healthcare system will greatly affect the nature of mesothelioma treatment protocol.
Leading doctors in this field such as Dr.Hedy Lee Kindler will also face changes as the government will streamline physician’s procedures.
In addition to the treatment implications that this new healthcare overhaul will present, the main controversy is focusing on the effects that it will have on our aging population. Mesothelioma patients are widely those of an older age group, due to the use of asbestos in naval shipyards and factories during the World War II-era. Using speech such as ‘death panels’ and ‘pulling the plug on grandma’, will not clear the conscious of the Americans who deeply rely on a stable healthcare system.
Arch Pathol Lab Med. 2009 Aug;133(8):1317-31.
Guidelines for pathologic diagnosis of malignant mesothelioma: a consensus statement from the International Mesothelioma Interest Group.
Husain AN,Colby TV,Ordóñez NG,Krausz T,Borczuk A,Cagle PT,Chirieac LR,Churg A,Galateau-Salle F,Gibbs AR,Gown AM,Hammar SP,Litzky LA,Roggli VL,Travis WD,Wick MR.
Department of Pathology,University ofChicago,Chicago,IL60631,USA. email@example.com
CONTEXT: Malignant mesothelioma (MM) is an uncommon tumor that can be difficult to diagnose. OBJECTIVE: To develop practical guidelines for the pathologic diagnosis of MM. DATA SOURCES: A pathology panel was convened at the International Mesothelioma Interest Group biennial meeting (October 2006). Pathologists with an interest in the field also contributed after the meeting. CONCLUSIONS: There was consensus opinion regarding (1) distinguishing benign from malignant mesothelial proliferations (both epithelioid and spindle cell lesions), (2) cytologic diagnosis of MM, (3) key histologic features of pleural and peritoneal MM, (4) use of histochemical and immunohistochemical stains in the diagnosis and differential diagnosis of MM, (5) differentiating epithelioid MM from various carcinomas (lung, breast, ovarian, and colonic adenocarcinomas and squamous cell and renal cell carcinomas), (6) diagnosis of sarcomatoid mesothelioma, (7) use of molecular markers in the differential diagnosis of MM, (8) electron microscopy in the diagnosis of MM, and (9) some caveats and pitfalls in the diagnosis of MM. Immunohistochemical panels are integral to the diagnosis of MM, but the exact makeup of panels used is dependent on the differential diagnosis and on the antibodies available in a given laboratory. Immunohistochemical panels should contain both positive and negative markers. The International Mesothelioma Interest Group recommends that markers have either sensitivity or specificity greater than 80% for the lesions in question. Interpretation of positivity generally should take into account the localization of the stain (eg, nuclear versus cytoplasmic) and the percentage of cells staining (>10% is suggested for cytoplasmic membranous markers). These guidelines are meant to be a practical reference for the pathologist.
PMID: 19653732 [PubMed - indexed for MEDLINE]
New Approach could make Diagnosing Mesothelioma Easier
Posted on April 9th, 2009 - by Deon Scott
According to a recent report a new approach is being looked into that could end up making it easier and faster to diagnose the deadly asbestos related cancer,mesothelioma. This is a form of cancer that is notoriously difficult to diagnose in time, and this is because it can take several decades for the symptoms to actually manifest, which means that it is often too late for effective treatment by the time the diagnosis has been made.
In a recent statement Michael Harbut, co-director of theNationalCenter for Vermiculite and Asbestos-Related Cancers which is based at the Barbara Ann Karmanos Cancer Institute inDetroit,Michigan said that there are high hopes that this new approach could make a big impact on public health.
He stated: “Radiographic approaches developed by Carmen Endress, Associate Professor of Radiology at Wayne State University School of Medicine, allow us to visualize lesions caused by asbestos exposure in three dimensional detail and often at a much earlier stage than that of the current standard radiographic techniques.”
It is thought that the new approach could help to make it easier to detect this type of disease, make it easier to tell the difference between various different forms of asbestos related diseases, and ultimately make it easier and faster to both diagnose and therefore treat asbestos related disease.
Clinical Impact and Reliability of Pleural Fluid Mesothelin in Undiagnosed Pleural Effusions
Helen E. Davies1, Ross S. Sadler2, Silvia Bielsa3, Nicholas A. Maskell4, Najib M. Rahman1, Robert J. O. Davies1, Berne L. Ferry2 and Y. C. Gary Lee1,3
1 Oxford Centre for Respiratory Medicine and University of Oxford, Oxford;2 Department of Clinical Immunology, Churchill Hospital, Oxford;3 Centre for Respiratory Research, University College London, London; and4 University of Bristol and Southmead Hospital, Bristol, United Kingdom
Correspondence and requests for reprints should be addressed to Y. C. Gary Lee, Ph.D., University Department of Medicine and Lung Institute of Western Australia, University of Western Australia, G Block, 4/F, QE II Med Ctr, Perth WA6009, Australia. E-mail: firstname.lastname@example.org
Rationale: Serum mesothelin is a new biomarker for the diagnosisofmesothelioma. Patients withmesothelioma commonly presentwith pleural effusions. To define the clinical utility of mesothelinquantification in pleural fluid, we assessed its additionalvalue over pleural fluid cytology and its short-term reproducibilityand reliability after pleural inflammatory processes, includingpleurodesis.
Objectives: To assess the diagnostic role of pleural fluid mesothelinand the effect of common clinical factors that may influencemeasurement accuracy.
Methods: Mesothelin was quantified in 424 pleural fluid and64 serum samples by ELISA. Fluid was collected prospectivelyfrom 167 patients who presented with pleural effusions for investigation.Serial pleural fluid samples were obtained from patients (n= 33) requiring repeated drainage. Mesothelin levels were alsomeasured in patients (n = 32) prepleurodesis and postpleurodesis.
Measurements and Main Results: Pleural fluid mesothelin concentrationswere significantly higher in patients withmesothelioma (n =24) relative to those with metastatic carcinomas (n = 67) andbenign effusions (n = 75): median (interquartile range, 25th–75thpercentile) = 40.3 (18.3–68.1) versus 6.1 (1.5–13.2)versus 3.7 (0.0–12.4) nM, respectively,P < 0.0001.Mesothelin measurement was superior to cytological examinationin the diagnosis and exclusion ofmesothelioma (sensitivity,71 vs. 35%; specificity, 89 vs. 100%; negative predictive value,95 vs. 82%, respectively). In patients with "suspicious" cytology,pleural fluid mesothelin was 100% specific formesothelioma,and in cytology-negative effusions (n = 105) offered a negativepredictive value of 94%. Intraindividual reproducibility ofpleural fluid mesothelin was excellent: mean (±SD) variation,–0.15 (±8.41) nM in samples collected within 7days from patients withmesothelioma. Measurements remainedreliable after pleurodesis and were not affected by the presenceof bacteria.
Conclusions: Pleural fluid mesothelin provides additional diagnosticvalue relative to cytological examination. Mesothelin measurementsare reproducible and not affected by inflammatory pleural processes.
Key Words: pleural effusion • mesothelin • biomarker •mesothelioma • pleura
AT A GLANCE COMMENTARY
Scientific Knowledge on the Subject
Serum mesothelin is adiagnostic biomarker formesothelioma. Pleural fluid valuesare significantly higher than serum levels and may offer additionalvalue over pleural fluid cytology for diagnosis of pleural malignancy.The clinical utility of pleural fluid mesothelin has not yetbeen defined.
What This Study Adds to the Field
This studydemonstrates that pleural fluid mesothelin is a valuable adjunctto cytological examination in patients with an undiagnosed pleuraleffusion. It is reproducible and not influenced by common inflammatorypleural processes.
Rosetta Genomics Announces Commercial Availability of Its Third MicroRNA-Based Diagnostic Test: miRview(TM) meso
Posted on: Monday, 29 December 2008, 07:30 CST
REHOVOT,Israel,JERSEY CITY,New Jersey andPHILADELPHIA,Pennsylvania, December 29 /PRNewswire-FirstCall/ -- Rosetta Genomics, Ltd. (NASDQ: ROSG), the leading developer of microRNA-based molecular diagnostics, announced today the introduction of its third diagnostic test, miRview(TM) meso. The test is now commercially available through Rosetta Genomics CLIA-certified lab inPhiladelphia.
To order the test, physicians may contact 1-888-522-7971, or visit the company's website http://www.rosettagenomics.com.
"I am very excited to finally see a molecularly-based test that can objectively differentiate mesothelioma from several types of carcinomas in the lung with such high level of accuracy" noted Harvey Pass, MD, Division Chief for Thoracic Surgery and Thoracic Oncology at theNew YorkUniversityLangoneMedicalCenter. "Ruling out Mesothelioma from lung cancer for individuals that were exposed to asbestos can be difficult and challenging. I am sure that this test will become an important tool for both oncologists and pathologists in obtaining the right diagnosis in these patients."
Malignant pleural mesothelioma is directly linked to exposure to asbestos particles, as well as to various heavy metals. Rescue workers, shipyard workers, and miners are at increased risk of developing mesothelioma. Currently, there is no single diagnostic test that is entirely conclusive for this differentiation. In addition, pathological diagnosis may suffer from significant inter-observer variability, and in the absence of a single specific and reliable test, mesothelioma can be difficult to identify from other cancers.
miRview(TM) meso differentiates mesothelioma, a cancer connected to asbestos exposure, from other carcinomas in the lung. Currently, there is no single diagnostic test that is entirely conclusive for this differentiation. Each year, approximately 130,000 patients in theUnited States are diagnosed with adenocarcinoma of the lung. miRview(TM) meso is available for $3170.
Rosetta Genomics currently has approximately $16M in cash, and it expects to perform approximately 2,000 tests during 2009 in its laboratory inPhiladelphia,PA.
The company is now offering the following ground-breaking tests through its clinical lab inPhiladelphia:
- miRview(TM) mets - This test can accurately identify the primary tumor site in patients presenting with metastatic cancer, as well in patients with Cancer of Unknown Primary (CUP). In theU.S., hundreds of thousands of patients are diagnosed each year with metastatic cancer, and approximately 70,000 patients are labeled CUP patients. miRview(TM) mets is available for $3650. - miRview(TM) squamous - This test differentiates between two subtypes of non small cell lung cancer (NSCLC). This diagnosis is important as some NSCLC patients have demonstrated varying response patterns ranging from a high incidence of severe or fatal internal bleeding in the lungs to overall poor response to treatment. In theUS alone, approximately 170,000 patients are diagnosed each year with NSCLC. miRview(TM) squamous is available for $3170. - miRview(TM) meso - This test differentiates mesothelioma, a cancer connected to asbestos exposure, from other carcinomas in the lung. Currently, there is no single diagnostic test that is entirely conclusive for this differentiation. Each year, approximately 130,000 patients in theUnited States are diagnosed with adenocarcinoma of the lung. miRview(TM) meso is available for $3170.
MicroRNAs (miRNAs) are recently discovered, naturally occurring, small RNAs that act as master regulators and have the potential to form the basis for a new class of diagnostics and therapeutics. Since many diseases are caused by the abnormal activity of proteins, the ability to selectively regulate protein activity through microRNAs could provide the means to treat a wide range of human diseases. In addition, microRNAs have been shown to have different expression in various pathological conditions. As a result, these differences may provide for a novel diagnostic strategy for many diseases.
About Rosetta Genomics
Rosetta Genomics (Nasdaq: ROSG) is a leading developer of microRNA-based molecular diagnostics. Founded in 2000, the company's integrative research platform combining bioinformatics and state-of-the-art laboratory processes has led to the discovery of hundreds of biologically validated novel human microRNAs. Building on its strong IP position and proprietary platform technologies, Rosetta Genomics is working on the application of these technologies in the development of a full range of microRNA-based diagnostic tools. The company have their first three microRNA-based tests, miRview(TM) squamous, miRview(TM) mets, and miRview(TM) meso, commercially available through its Philadelphia-based CLIA-certified lab.
Forward-Looking Statement Disclaimer
Various statements in this release concerning Rosetta's future expectations, plans and prospects, including without limitation, statements relating to the role of microRNAs in human physiology and disease, the potential of microRNAs in the diagnosis and treatment of disease and the timing of introduction of additional microRNA-based diagnostic tests, including miRview meso, miRview squamos and miRview mets, constitute forward-looking statements for the purposes of the safe harbor provisions under The Private Securities Litigation Reform Act of 1995. Actual results may differ materially from those indicated by these forward-looking statements as a result of various important factors, including risks related to: Rosetta's approach to discover and develop novel diagnostics and therapeutic tools, which is unproven and may never lead to commercially accepted products or services; Rosetta's ability to fund and the results of further pre-clinical and clinical trials; Rosetta's ability to obtain, maintain and protect the intellectual property utilized by Rosetta's products; Rosetta's ability to enforce its patents against infringers and to defend its patent portfolio against challenges from third parties; Rosetta's ability to obtain additional funding to support its business activities; Rosetta's dependence on third parties for development, manufacture, marketing, sales, and distribution of products; Rosetta's ability to successfully develop and commercialize its candidate tools, products and services; Rosetta's ability to obtain regulatory clearances or approvals that may be required for its products and services; the ability to obtain coverage and adequate payment from health insurers for the products and services comprising Rosetta's technology; competition from others using technology similar to Rosetta's and others developing products for similar uses; Rosetta's dependence on collaborators; and Rosetta's short operating history; as well as those risks more fully discussed in the "Risk Factors" section of Rosetta's Annual Report on Form 20-F for the year ended December 31, 2007 as filed with the Securities and Exchange Commission. In addition, any forward-looking statements represent Rosetta's views only as of the date of this release and should not be relied upon as representing its views as of any subsequent date. Rosetta does not assume any obligation to update any forward-looking statements unless required by law.
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SOURCE Rosetta Genomics Ltd