The mesothelium tissues made of mesothelial cells naturally exist as two layers – inner and outer ones. The inner layer covers and protects the internal organs namely heart, lungs, stomach and testicles. The space between the two layers has small quantity of fluid enabling easy movements of organs. The mesothelium covering the heart is pericardial mesothelium. The mesothelium around lungs is pleura where inner layer is visceral pleura while outer layer is parietal pleura. The mesothelium around abdomen organs, lining of abdomen walls and pelvis is called peritoneum. Its inner layer is called visceral peritoneum while outer layer is called parietal peritoneum. In addition, mesothelium is found lining the testicles. In normal circumstances, mesothelial cells grow like the rest of the cells and tissues in the body.
Yet, at times the normal growth of mesothelial cells and tissues become abnormal resulting in Mesothelioma. Some lucky people get non-cancerous or benign tumours called fibrous tumours that can be easily removed. However, most unfortunate cases get malignant cancer when nearby cells and/or tissues get destroyed leading to metastasis. According to doctors, Mesothelioma is rare and aggressive that can be benign or malignant cancer. Malignant cancer can be divided into four categories. These include lung (pleural mesothelioma), abdomen (peritoneal mesothelioma), heart (pericardial mesothelioma) and testicles. Of these, most common one is Pleural Mesothelioma reported amongst 70-80% of people with Mesothelioma. Another common one is Peritoneal Mesothelioma found amongst 25% of people with Mesothelioma. Other rarer types include Pericardial and Testicle Mesothelioma.
Historical Evidence of Global Mesothelioma
In 1970s, data on Pleural and Peritoneal Mesothelioma cases was collected from several countries. These included the UK, Scandinavian countries and parts of Canada and the USA. The data obtained varied greatly from one country to another. The quantity (tons) and quality of asbestos used in countries considered differed from one another. Also, there was variation in the different types of asbestos produced and/or inhaled/consumed.
Following countries showing number of cases (men per million) using/producing asbestos:
- Australia – 28.3
- Great Britain – 17.5
- Netherlands – 20.9
- South Africa – 33
- Australia – 28.3
Scientists used death certificates to compile the following data from industrial countries (Australia, Europe, and North America). Over the past 3-4 decades, rate of Malignant Mesothelioma in men has increased by 7-10% per annum. By 1960s, scientists knew Mesothelioma was predominately in Hawaii, San Francisco, and Seattle in the US. The common reason of all these areas was the exposure to asbestos in shipyards. In UK, it was reported that construction and maintenance workers exposed to asbestos got Malignant Mesothelioma. Hence, Malignant Mesothelioma and exposure to asbestos are directly associated as per scientific evidences.
Exposure to Asbestos – How it all Began?
In the 1930-40s, asbestos mining and milling industries became most popular. The usage of the same was at its peak around the 1950-1970s. Some of the popular countries where asbestos was mined and used were Australia, Canada, South Africa, Europe (Soviet Bloc) and the USA.
The best quality blue asbestos was produced at Wittenoom Mine, Western Australia (1948-1966). However, the very first widespread Mesothelioma epidemic was reported and confirmed by 1960s. It was not just in that part of the world. However, data collected globally proved asbestos exposure causes Mesothelioma.
Historically, Canada was one of the largest asbestos miners. The chrysolite asbestos in eastern Quebec was discovered in 1877. Thereafter, half of world’s asbestos was mined in Canada by 1880s. The concentration of asbestos industries in Canada was in Cowichan Valley, Capital and Greater Vancouver counties. Shipyards of Vancouver and Victoria used asbestos for shipbuilding and repair.
Three types of asbestos are mined in South Africa. The white coloured chrysotile (95%) found in serpentine rock mined in Eastern Transvaal and Swaziland. The greyish-brown coloured Amosite (1%) found in banded ironstone mined in Northern Transvaal. The blue and/or lavender-blue coloured Crocidolite (2%) found in banded ironstone mined in north-west Cape or Griqualand West, and Northern Transvaal.
The crocidolite was discovered near Prieska, North Cape (1806). Thereafter, asbestos trading began and its demand peaked before and during the First World War. After brief break, asbestos trading increased since 1930s, around Second World War and in 1950-60. Initially, asbestos was mined in small scale by farmers. Later, mining and milling was carried out in extensive scale. The asbestos fibres were cobbed from rocks by hand-held hammers and sieved by hand. These fibres were sieved sorted by hand and mechanical methods. Eventually, these were transported in Hessian sacks to various destinations. Women and children were employed for sorting and cobbing. People working for the Northern Cape Province crocidolite fields showed consistent symptoms for Mesothelioma. The pathological reports showed evidence of association of asbestos and Mesothelioma and this was accepted worldwide. This was because thousands of people had been exposed to asbestos for over 150 years.
The United States of America:
Mesothelioma rate in men was highest (1.9 per 100000 people) in 1992 but, constant amongst women. People born in 1925-30 were exposed asbestos while working in mines, shipyards, constructing and manufacturing factories. This was long before scientists knew asbestos exposure causes Mesothelioma. The residents of coastal Sates of Great Lakes, Florida, Washington and Oregon were more prone to Mesothelioma. This was due to asbestos exposure even in shipyards. In USA, reports showed carpenters, electricians, farmers, machinists, pipefitters, plumbers, and steamfitters mostly get Mesothelioma.
Evidence collected globally proved that primary exposure to asbestos in mines and mills caused Mesothelioma. Secondary asbestos exposure at industries including friction material, insulation materials, textiles, tiles are prone to Mesothelioma. Even bystanders and employees who are present in the atmosphere with asbestos end up with Mesothelioma. People dwelling in homes made with asbestos insulation, roofing, tiles and likewise get the ailment too.
(Reference: Robinson Bruce W. S. (MD,Professor of Medicine, University of Western Australia, Perth, WA, Australia), Chahinian A. Philippe (Professor, Division of Neoplastic Diseases, Mount Sinai Hospital, New York, NY, USA) Mesothelioma published by Martin Dunitz Ltd, a member of the Taylor & Francis group -First published in the United Kingdom in 2002)
Different Causes of Malignant Mesothelioma
Cancer occurs due to uncontrollable, multiple cell growth. This can happen due to gene mutation within a cell. The new cells synthesized in the body are not recognised by the immune system as foreign. Hence, they are not attacked or removed from the system. The reason for the advent of gene mutation is still a mystery. There are several theories that these are caused by inherited conditions, environment, health condition and life-style.
As already discussed, evidence clearly shows that people exposed to asbestos end up getting Mesothelioma. Asbestos are resistant to heat and are used for flooring, roofing, insulations, braking and other industrial products. People present in primary or secondary conditions can easily inhale and/or consume asbestos fibre or particles. Over time, these particles settle in lungs and/or stomach causing irritation leading to gene mutation resulting Mesothelioma. This ailment can become apparent within months or after 20-40 years depending on other health conditions. There are a few people who are immune to Mesothelioma even after years of asbestos exposure.
- Direct exposure to Asbestos at work and/or home.
- Family history of Mesothelioma increases risk of disease.
- Residing with Asbestos miner and/or factory worker who might carry fibre/particles home. Factory workers should shower and change clothes before leaving workplace.
Symptoms of Mesothelioma
Mesothelioma is a serious illness. If you get exposed to asbestos for limited or extended period of time, then consult your doctor. It is always best to be safe and take early precautions to get well soon.
Following are the common symptoms of Mesothelioma:
- Body – Constant fatigue, muscle weakness, Chest/Abdomen pain
- Lungs – Fluid collection (Pleural effusion), complicated respiration
- Overall – Fever, night sweats
- Respiration – Complicated, Dyspnea (shortness of breath)
- Throat – Dry cough and/or wheezing
People exposed to asbestos should seek cancer screening that would help in early detection of Mesothelioma. These early diagnoses of Mesothelioma can be detected through routine X-rays and/or blood tests. When caught in early stage, there is a better chance of getting cured. Here are the signs/symptoms doctors look out for in the two different stages.
- Cough – Dry and/or wheezing
- Lungs – Pleural effusion (fluid build-up)
- Pain – Chest and/or abdomen
- Respiration – Dyspnoea (Shortness of breath), breathing difficulties
- Digestive System – Swallowing difficulties, appetite loss, weight loss, bowel problem
- Pain – Increased
- Respiratory – Complicated
The treatments of four categories of Mesothelioma have been discussed in details as follows:
- Most common amongst working men
- Caused by inhaling asbestos that is hazardous to health.
- Latency is 20-50 years so affects elderly people who are over 75 years.
- Found in outer lining of lungs and/or inner lining of chest cavities.
- Symptoms –
- Body – Fatigue, Fever, Night Sweats, Weight Loss, Lumps under skin on chest.
- Breath – Shortness
- Cough – Dry, Constant and coughing up blood.
- Pain – Chest, Lower back, rib area.
- Swallowing – Difficulty
- Swelling – Face and arms.
- Stages 1 and 2 are known as early stages when tumour is localised and curable. Treatment includes combination of surgery, chemotherapy, radiation. Stages 3 and 4 occur when spreading or metastasis occurs. The International Mesothelioma Interest Group suggests using tumour-node-metastasis (TNM) approach including multimodal immunotherapy.
- Life expectancy is less than 18 months. Some can live longer with treatment.
- Found in 10-20% cases
- Growth can appear on both layers of surrounding the abdomen.
- Symptoms –
- Abdomen – Pain, swelling, tenderness
- Abdomen Condition – Fuller, Constipation or Diarrhoea
- Digestive System – Anaemia, Nausea or vomiting, Weight loss,
- Body – Fever/Flu, Night sweats, hernias
- Stages 1 and 2 can be surgically cured since the tumour is in the abdominal lining and lymph nodes are not affected. Stage 3 the cancer cells move outside the peritoneal lining and lymph nodes.
- Treatment – Combination of cytoreductive surgery with heated intra-peritoneal chemotherapy (HIPEC). Some of the Chemotherapy drugs include carboplatin, cisplatin, gemcitabine and pemetrexed. Radiation therapy causes long-term damages so it is not recommended. Alternative treatments include Immunotherapy or boosting body’s immune system.
- Life expectancy is around a year. However, depending on the stage and treatment it can be extended to over 5 years.
- Second-rarest type found in 1% cases and in 60% men.
- Develops on soft lining around the heart.
- Diagnosed in people aged between 50-70 years, mostly aged 56 years.
- Symptoms –
- Body – Fatigue, Fever, Night sweats
- Breathe – Dyspnea (difficulty in breathing while resting), shortness of breath while lying flat
- Chest – Pain
- Heart – Arrhythmia (palpitations and/or irregular heartbeat), murmurs
- Physical – Build-up of fluids, thickness of pericardial layers
- Throat – Cough
- Diagnosed using computed tomography (CT) scans and Magnetic Resonance Imaging (MRI). Also, biopsy help in critical diagnosis.
- Best treated with a multimodal approach including surgery, chemotherapy and treatment of symptoms. Radiation is not used because it permanently damages cells.
- Life expectancy is 6-10 months but, with treatment people live for years after treatment.
- Rarest type of Mesothelioma
- Develops on the lining of the testes
- Symptoms –
- Pain and swelling of testes.
- Hydrocele – Build-up of fluid in scrotum
- Diagnosed via ultrasound and image scanning and biopsy
- Treatment – Surgical removal of affected testicle and spermatic chord. Additional chemotherapy and radiation therapy. Sometimes, surgery is carried out after chemotherapy with cisplatin and pemetrexed. At times, doctors offer radiation therapy to kill any remaining cancer cell preventing its return. When found in early stage, chemotherapy and radiation therapy are skipped. Doctors also use HIPEC therapy as discussed earlier in case of peritoneal Mesothelioma.
- Life Expectancy – 20-23 months. Yet, one patient survived for over 15 years.
There are no standard therapeutic methods for treating the four types of Mesothelioma. The treatment totally depends on the stage when the growth is diagnosed. Like treatment of other cancers, when found in early stages, it is curable. However, treatment becomes complicated after metastasis. This is because Mesothelioma may not respond to chemotherapy. In addition, radiation therapy can cause long-term damage to even good and healthy cells.
As a result, several modern clinical centres use multimodal therapies. These modern technical processes include experimental treatments such as immunotherapy and gene therapy. Moreover, gene therapy can comprise of suicide gene therapy and/or immunological gene therapy. These techniques have been used by scientists representing and belonging to the International Mesothelioma Interest Group. Every 2 years for the past decade, this group meets and shares clinical and scientific information. The fresh tumour cells can be extracted from pleural fluid and combined with latest DNA array procedures. This would help in studying carcinogbioenesis (cell tumour formation) resulting in better medical approaches for cure.
When to see a Doctor?
By now, you should agree that any exposure to asbestos means you must call the doctor. Waiting till you notice any sign or symptom causing the four types of Mesothelioma would be too late. The common symptoms develop in the later stage when Mesothelioma can become untreated. Hence, you should contact medical centres well versed with diagnosis and treatment of Mesothelioma. This is because certain symptoms of Mesothelioma are similar to illnesses like Tuberculosis, lung cancer and abdomen cancer.
Here is a list of all hospitals that treat Mesothelioma in India.
1. GIOSTAR Stem Cell Therapy
Address: Gurudwara, Building ‘N’, Mondeal Business Park Near, Sarkhej – Gandhinagar Hwy, Thaltej, Ahmedabad, Gujarat-380054
2. Ved Speciality Hospital
Address: P Mondeal Business Park Nr. Gurudwara, S.G. Highway, Thaltej, Ahmedabad, Gujarat-380054
1. Apollo Hospitals Bannerghatta
Address: 154/11, Bannerghatta Main Rd, IIM Opposite, Krishnaraju Layout, Amalodbhavi Nagar, Panduranga Nagar, Bengaluru, Karnataka-560076
Mobile: +91-8026304050, +91-8041463151
2. Apollo Specialty Hospital
Address: 21/2 (Old No.2), 14th Cross, 3rd Block, Jayanagar, Bengaluru-560 011
Mobile: +91-8030804444, +91-8030804666
3. BGS Gleneagles Global Hospitals
Address: 67, Uttarahalli Main Road, Bengaluru, Karnataka-560060
4. Fortis Hospital
Address: 154/9, Bannerghatta Road, Opposite IIM-B Sahyadri Layout, Panduranga Nagar Bangalore, Karnataka-560076
Phone: +91-96633 67253
5. Narayana Hrudhayalaya Multispeciality Hospital
Address: Plot Number 3 & 4, Sadaramangala Industrial Area Landmark: Next to Prestige Shantiniketan, Whitefield, Bangalore, Karnataka-560066
1. Apollo Hospitals, Greams Road
Address: No: 21, Greams Lane, Off Greams Road, Chennai, Tamil Nadu-600006
2. Apollo Speciality Cancer Hospital
Address: Padma Complex, 320, Anna Salai, Rathna Nagar, Alwarpet, Chennai, Tamil Nadu-600035
3. Dr. Rela Institute and Medical Centre, Chennai
Address: No. 7, Works Road, Chromepet, Chennai, Tamil Nadu-600044
4. Fortis Malar Hospital
Address: No. 52, 1st Main Rd, Gandhi Nagar, Adyar, Chennai, Tamil Nadu-600020
5. Gleneagles Global Hospitals, Chennai
Address: 439, Cheran Nagar,Perumbakkam,Chennai Tamil Nadu-600001
1. BLK Super Speciality Hospital
Address: Pusa Rd, Radha Soami Satsang, Rajendra Place, New Delhi, Delhi-110005
2. Dharamshila Narayana Superspeciality Hospital, New Delhi
Address: Vasundhara Enclave, Near New Ashok Nagar Metro Station, Dallupura, New Delhi, Delhi-110096
Contact No: 18602080208, +91-7370073700
3. Fortis Escorts Heart Institute, New Delhi
Address: Okhla road, Sukhdev Vihar Metro Station, New Delhi, Delhi-110025
4. Fortis Flt. Lt. Rajan Dhall Hospital, Vasant Kunj
Address: Aruna Asaf Ali Marg, Pocket 1, Sector B, Vasant Kunj, New Delhi, Delhi-110070
5. Indraprastha Apollo Hospitals
Address: Sarita Vihar, Delhi Mathura Road, New Delhi-110076
Mobile: +91-1126925858/5801, +91-1126825563
6. Manipal Hospital Delhi
Address: Palam Vihar, Sector 6 Dwarka, New Delhi, Delhi-110075
7. Max Super Speciality Hospital, Patparganj
Address: 108A, IP Ext, I.P.Extension, Patparganj, Delhi-110092
8. Max Super Speciality Hospital, Saket
Address: Press Enclave Road, Mandir Marg, Saket, New Delhi, Delhi-110017
9. Max Super Speciality Hospital, Shalimar Bagh
Address: C and D Block, Shalimar Place Site, Shalimar Bagh, New Delhi, Delhi-110088
10. Moolchand Medcity
Address: Lala Lajpat Rai Marg, Near Moolchand Metro Station, Block M, Lajpat Nagar III, Lajpat Nagar, New Delhi, Delhi-110024
11. Nutech Mediworld
Address: H, 8, Green Park Ext Rd, Block N, Green Park Extension, Green Park, New Delhi, Delhi-110016
12. Primus Super Speciality Hospital
Address: Chandragupta Marg, Opp Russian Embassy, Chanakyapuri, New Delhi, Delhi-110021
13. Pushpawati Singhania Hospital & Research Institute
Address: Press Enclave Marg, J Pocket, Phase II, Sheikh Sarai, New Delhi, Delhi-110017
14. Rockland Hospital
Address: B-33-34, Block B, Qutab Institutional Area, New Delhi, Delhi-110016
15. Sir Ganga Ram Hospital
Address: Old Rajinder Nagar, Rajinder Nagar, New Delhi, Delhi-110060
16. Venkateshwar Hospital
Address: Sector 18, Sector 18A Dwarka, Dwarka, New Delhi, Delhi-110075
Delhi – Neighbourhood:
1. Apollo Hospitals, Noida
Address: E 2, Sector 26 (Adjacent to Club 26), Noida, Uttar Pradesh-201301
Contact No: +91-1204012000 / Extn: 1007, +91-1202445355
2. Artemis Hospital Gurgaon
Address: Near Unitech Cyber Park, Sector 51, Gurugram, Haryana-122001
3. Fortis Healthcare Ltd.
Address: Tower A, Unitech Business Park, Block – F, South City 1, Sector – 41, Gurgaon, Haryana-122001
Mobile: +911244921021, +911244921071, +911244921033
4. Fortis Hospital, Noida
Address: B-22, Sector 62, Noida, Uttar Pradesh-201301
Contact No: +91-1204300222
5. Fortis Memorial Research Institute
Address: Opposite HUDA City Centre, Sector 44, Gurugram, Haryana-122002
6. Max Hospital, Gurgaon
Address: B Block, Sushant Lok 1, Near Huda City Centre, Gurugram, Haryana-122001
7. Medanta – The Medicity
Address: CH Baktawar Singh Road, Sector 38, Gurugram, Haryana-122001
8. Millennium Cancer Center
Address: Plot No.6, Ground Floor, Sector 44, Gurugram, Haryana-122003
9. Nayati Medicity
Address: NH 2, Goverdhan Chatikara, Bypass, Nayati, Mod, Uttar Pradesh-281001
10. Paras Hospitals
Address: Phase- I, C-1, Sushant Lok Rd, Block C, Sushant Lok Phase I, Sector 43, Gurugram, Haryana-122002
11. Sarvodaya Hospital
Address: YMCA Road, Sector-8, Near ESI Hospital, Block A, Faridabad, Haryana-121006
1. Aware Global Hospital
Address: 8-16-1, Nagarjuna Sagar Road, Laxmi Enclave, Bairamalguda, LB Nagar, Hyderabad, Telangana-500035
1. Aster Medcity
Address: Kuttisahib Road Cheranalloor, South Chittoor, Kochi, Kerala-682027
1. Apollo Gleneagles Hospitals, Kolkata
Address: 58, Canal Circular Road, Kadapara, Phool Bagan, Kankurgachi, Kolkata, West Bengal-700054
2. Fortis Hospital Anandapur
Address: 730, Eastern Metropolitan Bypass, Anandapur, East Kolkata Twp, Kolkata, West Bengal-700107
1. Dayanand Medical College and Hospital, Ludhiana
Address: Tagore Nagar, Civil Lines Ludhiana, Punjab-141001
1. Fortis Hospital Mulund
Address: Mulund Goregaon Link Rd, Industrial Area, Mulund West, Mumbai, Maharashtra-400078
2. Global Hospital (Mumbai)
Address: 35, Dr. E Borges Road Opp Shirodkar High School, Parel, Mumbai, Maharashtra-400012
3. Jaslok Hospital
Address: 15, Dr. Deshmukh Marg, Pedder Road, Mumbai, Maharashtra-400026
4. Kokilaben Dhirubhai Ambani Hospital, Mumbai
Address: Rao Saheb, Achutrao Patwardhan Marg, Four Bungalows, Andheri West Mumbai Maharashtra-400053
5. Nanavati Hospital
Address: S V Road, Vile Parle West, Mumbai, Maharashtra-400056
6. Saifee Hospital
Address: 15/17, Maharshi Karve Rd, Opera House, Girgaon, Mumbai, Maharashtra-400004
7. SevenHills Hospital
Address: Marol Maroshi Rd, Shivaji Nagar JJC, Marol, Andheri East, Mumbai, Maharashtra-400059
8. Wockhardt Hospitals
Address: 1877, Doctor Anandrao Nair Marg, Near Agripada Police Station, Mumbai Central East, Mumbai, Maharashtra-400011
1. Kerala Institute of Medical Sciences
Address: 1, Anayara Road, Anayara, Thiruvananthapuram, Kerala-695029
If you wish to consult Mesothelioma specialist, then you can make online appointment and arrangements from home. You need not be a local resident or even a resident of India. You can take the advantage of obtaining best international care. The websites of each hospital and/or heath care centre have been provided. Feel free to contact them from the comfort of your home. Also, you can select your best choice comparing health care facilities and quotations offered by each health care centre.
We conclude that slight exposure to asbestos whether primary or secondary, you should take necessary precautions to remain healthy. If you suspect you have inhaled or swallowed any asbestos dust particles of fibres, seek medical screening. Ensure you do not have any particles lodged especially in your lungs or stomach. You do not want to end up with any type of Mesothelioma after its latency period, especially post retirement during senior age.