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Mesothelioma is a rare cancer of the chest and abdominal lining, which primarily affects people who have had work-related exposure to asbestos particles. According to the National Cancer Institute's SEER database, between 1973 and 1999, 5,266 Mesothelioma cases were recorded in the U.S.

At present, mesothelioma is considered to be an incurable tumor. For patients with early stage (stage I or II) disease, the 5-year survival rate is approximately 20 percent. Survival rates are lower if the primary surgery used to treat the tumor is done at a hospital or medical center with little experience treating this uncommon, difficult-to-treat disease. The survival rates increase when an individual with mesothelioma is treated at a medical center that has a relatively high volume of mesothelioma cases -- centers like Memorial Sloan-Kettering, whose experienced, multi-disciplinary mesothelioma team treats approximately 100 patients a year.

" There are only a few other institutions in the country that match our experience treating mesothelioma," says Valerie W. Rusch, MD, Chief of the Thoracic Service at Memorial Sloan-Kettering. "Sometimes, a patient is diagnosed in his community and receives various interventions, which limit our ability to deliver the most appropriate care. Therefore, the "first stop" for these patients should always be a medical center with expertise."

In most instances, the first symptom someone with mesothelioma will experience is an abnormal collection of fluid between the thin layers of tissue, or pleura, lining the lung and the wall of the chest cavity -- a condition known as pleural effusion. In some cases, chest pain will also be present. Proper diagnosis is often delayed for a period of months because many primary care physicians have had little experience with this rare disease. In addition, primary care physicians may make repeated attempts to reach a diagnosis by examining pleural fluid, which may or may not provide enough material to guarantee a definitive diagnosis.
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New therapies and approaches continue to be tested and developed through the use of clinical trials. For example, Memorial Sloan-Kettering investigators are spearheading a Phase II multi-center clinical trial that is testing the effectiveness of a process called induction chemotherapy for the treatment of pleural mesothelioma.

Since pleural mesothelioma is a difficult disease to treat with any single type of therapy such as chemotherapy, surgery, or radiation therapy, the primary goal of this study is to determine how effectively chemotherapy can completely shrink mesothelioma when it is given prior to surgery and radiation therapy, and whether it might improve life expectancy.

" When I started treating patients with this disease 22 years ago, the commonly accepted belief was that everyone died within two years of diagnosis," Dr. Rusch explains. "Fortunately, that's not the case anymore."

M E S T H E L I O M A • U P D A T E
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