Well-Differentiated Papillary Mesothelioma

What is Papillary Mesothelioma?



Well-differentiated papillary mesothelioma (WDPM) of the peritoneum is a rare subtype of peritoneal epithelioid mesothelioma which typically has low malignant potential. This form of mesothelioma, in contrast with the conventional diffuse malignant mesothelioma (DMM), is considered to be of low malignant potential, or not likely to spread or invade other parts of the body.

It most commonly occurs in young women lacking a history of asbestos exposure. Only 38 female patients with peritoneal WPDM have been reported in the literature, and no uniform treatment recommendation has been established.

Well-Differentiated Papillary Mesothelioma.

Department of Pathology, Duke University Medical Center, Durham, North Carolina 27710, USA. butno001@mc.duke.edu

Well-differentiated papillary mesothelioma is an unusual variant of epithelial mesothelioma considered to be of low malignant potential.

The majority of previously reported cases developed in the peritoneum of young women without a history of asbestos exposure. The authors report 14 cases of well-differentiated papillary mesothelioma, seven of which originated in the pleura, six in the peritoneum, and one in the tunica vaginalis. Eleven of the patients were male and three were female, with an average age at presentation of 58 years (range 32-82 years). Six of the patients had a quantifiable history of asbestos exposure. Of the nine cases with complete follow-up, six had clinically indolent disease, one showed resolution after adjuvant chemotherapy, one pursued an aggressive course, and one died of other causes. These findings indicate that well-differentiated papillary mesothelioma is a rare variant of mesothelioma with a variable clinical prognosis that is etiologically related to asbestos exposure in some cases.

PMID: 11688466 [PubMed - indexed for MEDLINE

Macroscopic features: Multiple grey white nodules usually less than 20mm in diameter.

Microscopic features:

Well defined stout papillary structures with myxoid cores, lined by bland, flattened, single layer of cuboidal or columnar mesothelial cells. Subnuclear vacuolation may be noted. Mitotic figures are rarely present. In some cases there may be limited invasion of the submesothelial layer. Deep invasion is usually not seen.

Differential diagnosis:

1. Reactive mesothelial hyperplasia (assocciated with inflammation) ;
2. Serous neoplasia of peritoneum ( cellular stratification, atypia and mitotic figures) ;
3. Primary and seconday adenocarcinoma (mucin histochemistry and immunohistochemistry are useful ) ;
4. Diffuse mesothelioma with a prominent tubulopapillary epithelial component (diffuse growth pattern & cytological atypia).
   

Papillary Mesothelioma Treatments

Due to the rare occurrence of this disease, a recommendation of uniform treatment has yet to be established. The typical forms of treatment that have been documented in various studies are similar to traditional mesothelioma treatments and have included surgery and multiple forms of chemotherapy. Patients and their families often have numerous questions about the best way to combat mesothelioma and we offer a comprehensive packet with information about treatment options and top doctors, catered to each patient’s specific diagnosis. Please click here to receive this complimentary packet overnight.

Read More.....

Mesothelioma Nutrition

Did You Know?

It is important to drink as much as possible in order to maintain your body’s system. The more you drink, the more your digestive system will be able to function properly, which will then help the rest of your body to be supported and stabilized.

For most mesothelioma patients, diet is often an overlooked subject, but eating the right nutritional foods for strength and energy is just as important as taking the proper medication.

Mesothelioma patients undergoing treatment should follow a special cancer diet devised by their nutritionists. Cancer diets involve eating the correct amounts of protein and calories as well as drinking the right amount of water to keep the ailing body replenished and energized. The body needs plenty of nourishment when it is going through chemotherapy or even when the patient is taking certain medications.

As with most cancers, along side traditional treatment changing your diet can help. Increase soy beans products in your diet, the alpha carotene and lycopene in soy help to revert and reduce tumor growth and metastasis. Other anti-cancer foods that should be plentiful in your diet are cabbage, kale, Brussels sprouts, shiitake mushrooms, broccoli, pears, citrus fruits, turmeric, tomatoes, blackberries, raspberries, blueberries, green tea, walnuts, spinach, wheat bran, rice bran, rosemary, garlic, thyme, oregano and onions. These foods should be organic. Cut down on meat (especially grilled or barbecued) and dairy food consumption, pickled food, smoked food, alcohol, saturated fats, salt, sun exposure and smoking.

Mesothelioma Nutrition

The following supplements may help if you are suffering from Mesothelioma.
Multivitamins and Multiminerals

* B group vitamins
* Vitamin E
* Vitamin A
* Vitamin C
* Vitamin D
* Vitamin K
* Co-enzyme Q10
* Echinacea
* Shark cartilage
* Fish Oil
* Selenium
* Zinc
* Manganese
* Copper
* Calcium
* Pro-biotics
* Evening primrose oil

Source: Stewart Hare C.H.Ed Dip NutTh

Below are some of the important nutrients patients are encouraged to include in their mesothelioma diet:

• Protein is important for any cancer patient because it helps repair tissue damaged by surgery, chemotherapy, or radiation. Protein also helps maintain a strong and healthy immune system, lowering a mesothelioma patient’s risk of infection after aggressive cancer treatments. The National Cancer Institute recommends increasing protein in a cancer diet with cheese, milk, ice cream, yoghurt, eggs, nuts, peanut butter, meats and fish.
• Fats are an essential part of the cancer diet because they supply the body with the necessary energy it needs while undergoing treatment. The amount of fats (meaning the number of calories) a cancer diet should consist of is dependent on a mesothelioma patient’s age and body size. The National Cancer Institute recommends increasing caloric intake with such foods as butter, milk, cheese, honey, sugar, granola and dried fruits.
• Water is another essential element of the cancer diet. Without a substantial amount of water, the body will dehydrate. It is important that anyone undergoing cancer treatment receive enough water to keep their bodies hydrated and replenished.
• Vitamins and minerals: Vitamins and minerals help ensure growth and development, in addition to allowing the body to use the calories supplied by the foods eaten. While it is not always necessary to supplement vitamins and minerals during times when one is maintaining good eating habits, it may become more important when the challenges of being ill or undergoing treatment make eating difficult.
  

The details of every patient’s mesothelioma diet will vary. Some patients will need to incorporate more fat into their diets, while others may need more protein. It is important that patients devise a cancer diet under the guidance of their doctor and nutritionist to ensure that they receive the proper amount of nutrients to improve their quality of life.

Source: MesotheliomaAttorneyAdviceCenter (www.maacenter.org).

Diet and Nutrition for Mesothelioma Patients

Eating a healthy diet that contains all the essential nutrients can be a challenge for anyone. But for people with mesothelioma and other cancers, this challenge is even more difficult. Although loss of appetite and nausea are common in people with mesothelioma, eating a healthy, balanced diet becomes more important than ever. Proper nutrition helps to boost the immune system, maintain energy levels and fight the free radicals that can cause cancer. In addition, diet and nutrition can play an important role in reducing the toxic side effects of some mesothelioma treatments.

If you or someone you know has mesothelioma, here are some diet and nutrition tips for fighting the disease and living well while undergoing treatment.

• A consultation with a dietician can help you create a nutritious meal plan that is tailored to your needs.
• Most sources recommend a lower-carbohydrate diet for people with cancer. At the same time, higher amounts of protein can help repair tissue damaged by surgery or treatments. It can also help to maintain a healthy immune system.
• Include fats in your diet to help supply your body with the energy it needs.
• Drink plenty of water to keep your body hydrated and flush out the toxins produced by mesothelioma treatments.
• If loss of appetite prevents you from eating more than a few bites at each meal, you can boost your caloric intake and avoid excessive weight loss by consuming high-calorie foods. These include butter, milk, cheese, honey and sugars.
• Focus on liquids and soft foods if you are nauseated or have difficulty swallowing. Blended drinks such as fruit smoothies may be more tolerable than solid foods. Commercially prepared liquid diet supplements are also useful.
• To be sure you are getting enough of the nutrients you need, you may want to ask your doctor if nutritional supplements are right for you.
  

resource : All About Mesothelioma

Read More.....

Organic Foods For Mesothelioma Cancer

For most mesothelioma patients, diet is often an overlooked subject, but eating the right nutritional foods for strength and energy is just as important as taking the proper medication.

As with most cancers, along side traditional treatment changing your diet can help. Increase soy beans products in your diet, the alpha carotene and lycopene in soy help to revert and reduce tumor growth and metastasis. Other anti-cancer foods that should be plentiful in your diet are cabbage, kale, Brussels sprouts, shiitake mushrooms, broccoli, pears, citrus fruits, turmeric, tomatoes, blackberries, raspberries, blueberries, green tea, walnuts, spinach, wheat bran, rice bran, rosemary, garlic, thyme, oregano and onions. These foods should be organic. Cut down on meat (especially grilled or barbecued) and dairy food consumption, pickled food, smoked food, alcohol, saturated fats, salt, sun exposure and smoking.

Organic food is natural food as against genetically modified (GM) food. Most food that we consume today are coated with chemicals and fertilizers. They are also genetically altered to yield more, which results in more quantity but not in quality. Organic food produce is healthier because they contain 50% more vitamins, minerals, enzymes and other micro-nutrients than intensively farm produced.

In the production of organic foods:

* Toxic pesticides are not used
* Soil fertility is maintained and replenished using natural methods such as crop rotation, fertilizer crops, composting etc.
* Regular soil and nutrition analysis are done to test soil fertility and food quality
* Natural methods of topsoil management are used to ensure minimal soil erosion
* Organic farmers aim to preserve and protect natural wildlife, vegetation and water systems
* Organic farmers are concerned about the loss of a variety of species
* No genetically modified seeds are used
* Organic growers collect seeds from the plants in order to preserve biodiversity

Why Organic food is better for you?

It is said that an apple you buy in the market today has on an average of 20-30 artificial poisons on its skin, even after rinsing. Organically produced food and flowers also taste and smell so much better. Fruits, flowers and vegetables are full of juice and flavor, and they come in many different varieties. Compare an organically produced rose fragrance with those that are sold en masse in the floral markets. The ones that are farm produced only look good but they don't even smell like roses, what's a rose without its fragrance?

For meats "organic" means that the animals have been raised without the use of growth factors and antibiotics. They are also fed on natural grass. This type of meat is also called "free range". You can see the same wording on organic eggs as well.

Organic and Natural mean different things. Don't be fooled by nutrition labels and packaging, stating that the food is Natural. It might be natural, but it's not organic.

"Natural" simply means that the food is unprocessed, it is fresh. "Organic" food on the other hand means food that has not been sprayed with pesticides, fertilizers, or no waste materials have been used while the food is being grown. Also, such food has not been genetically modified (GMO).

So, why is it better to buy organic food? I recently read an interesting fact. According to the Environmental Working Group (Washington D.C.) an apple grown on chemicals can have as many as 36 different pesticides sprayed on it. What does this tell you? Is it safer to shell out a little more especially for produce or it's not?

The same with meat. Antibiotic use can cause resistant bacterial strains. That's the reason why many antibiotics don't work and can't effectively cope with a lot of diseases nowadays. Growth hormones don't allow for the animal to grow naturally.

Eat healthy, live healthy: Awareness about the products you consume is the key and many non profit organizations are campaigning against non organic and health hazardous products. It is not very far fetched to say that what you eat today has a direct impact on the health of the future generation. Go organic!

ARE ORGANIC FOODS REALLY HEALTHIER FOR YOU?

Walter J. Crinnion N.D.

Published in Organic Gardening Almanac, 1995; Llewelyn Pub.

The more I work with chronically ill people, the bigger my organic garden gets. As a naturopathic physician I deal with a lot of chronically ill people. Many of them have been through the conventional medical system with no success, so they show up at my doorstep. One day Steve showed up. Over six feet tall and 200 pounds, he dwarfed me, and was quick to mention that my hair was thinning. He was always trying to be helpful. He came to me after numerous doctors were unable to help. By the time he arrived he was sure that he was dying. His long list of symptoms, coupled with his natural tendency to do his best to get your goat had no doubt caused any practitioners to give up on him.

Routine blood tests failed to show the cause of his problems, although they did show some irregularities. The really interesting finding came when we checked his blood for pesticides.

We tested for eighteen of the more common pesticides and found that he had nine of them running around in his blood. Knowing that there are many more than eighteen chemicals in our environment did not make me feel any better. If he had 50% of the chemicals that we tested for, how many did he have that we didn't test for? Unfortunately, out of the 70,000 chemicals in daily use in this country, only about 250 can be tested for in humans. This obviously makes it very difficult to find out what is causing a health problem if the culprit is one of the remaining 69,750.

After finding what I thought to be the source of Steve's problems I had to ask: Where did he get such a high level of toxins? One of the toxins he had in his serum was DDT. This chemical pesticide was banned in 1972 as a direct result of Rachel Carson's book Silent Spring. After being in the body for 6 months, DDT breaks down to DDE. Since we found both DDE and DDT in him, this meant that Steve had gotten DDT with the past year. But how?

While DDT is banned for use in this country it is still manufactured here, and then it is shipped to other countries for use in agriculture and mosquito control. DDT makes its way back into this country on the food raised in those countries, or in the livestock that was raised on contaminated feed.

Steve was a traveling salesman in the Pacific Northwest. His territory included Washington, Oregon, Alaska, Idaho, and Montana. He ate out at restaurants a lot while he was traveling. Presumably, that is where he was slowly poisoned. After seeing Steve, my backyard organic garden got a little bit bigger.

There are numerous benefits to both eating organic foods, and to organic gardening. I personally believe that a huge benefit comes from a renewed relationship with nature. It starts with an "I won't poison you, you won't poison me" attitude, and ends with "I'll nurture and respect you, you nurture and respect me." Doing your own organic gardening makes this a personal commitment. Gardening is just plain good for the soul. One of my patients told me that they refer to their time spent in the garden a "going to see my therapist." There is nothing quite like getting your hands in the soil for really good "grounding".

In addition to the mental and emotional benefits of growing and eating organic food, there are also the physical benefits. These physical benefits can be boiled down to nutrients present in organic foods that are not in commercial foods and toxins not in organic foods that are present in commercial foods. A recent article in the Journal of Applied Nutrition gave credence to the notion that organic foods have higher nutrient levels that non-organic food. In this study the mineral content of organic apples, pear, potatoes, wheat, and sweet corn were compared to commercial varieties. Overall the organic foods showed much higher levels of nutrient minerals and much lower levels of heavy metals.

Here are a few of the nutrients that were found in higher levels in the organic foods:

* Chromium is a micronutrient that is low in Western diets. Its deficiency is associated with the onset of adult diabetes and atherosclerosis (hardening of the arteries). Chromium was found to be higher in organic foods by an average of 78%.

* Selenium is one of the antioxidant nutrients that protects us from damage by environmental chemicals. It is protective against cancers and heart disease. It was found to be an average of 390% higher in organic foods.

* Calcium, needed for strong bones, averaged 63% higher in organics.

* Boron, which has been shown to help prevent osteoporosis (along with calcium), averaged 70% more.

* Lithium, which is used to treat certain types of depression, was 188% higher.

* Magnesium, which reduces mortality from heart attacks, keeps muscles from spasming, and eases the symptoms of PMS, averaged 138% more.

In short, many of the minerals that I most often prescribe to my patients are found in much higher levels in organic foods.

Other studies have looked at vitamin levels of food plants treated with certain pesticides. They showed that application of some pesticides would significantly lower the vitamin levels in the plants they were applied to. This is different than the notion that plants raised with chemicals are low in nutrients because the soil is depleted. This shows that chemicals actually reduce the amount of nutrients in plants after application. The nutrients most often affected are vitamin C, beta carotene, and the B vitamins. These nutrients are vitally necessary for the body to withstand the onslaught of chemical toxins. Vitamin C has been well documented by two-time Nobel laureate Linus Pauling to prevent and treat cancers. Beta carotene has been shown to be a stimulant of the immune system, and is sometimes able to prevent lung cancer.

When they studied organic food for mineral levels, the researchers also looked for the amount of the heavy metals aluminum, cadmium, lead and mercury. Aluminum has been implicated for years in the development of Alzheimer's disease. It's content in organic food averaged 40% less that in commercial foods. Lead toxicity, which has been in the new a lot lately, can adversely affect our children's' IQ. It averaged 29% lower in organic foods. Mercury, which can cause neurologic damage, averaged 25% lower in organic foods.

Besides the lower levels of heavy metals, there are the chemical residues themselves. The big question is whether or not the accumulation of pesticide residues in non-organic foods is a real health concern or not. Studies have never been able to conclusively show a direct correlation between residues in food and a decline of human health, but there are numerous problems in doing any such study. The first is that you would need a population of people who are free of chemical residues to compare to, and no one has been able to find such a group. According to an ongoing EPA study of fat samples taken from surgeries and autopsies across the country, we are all loaded with chemical residues. Similar studies done on other countries all show the same results.

The clearest studies that we have about pesticide residues and disease are those looking at breast cancer. In the last few years there have been a series of studies, each building upon the other, looking at the level of DDT, DDE, and PCB in women, They have very clearly shown that chemical residues in the serum and fat cells of women greatly increase the risk of breast cancer. Since breast cancer is a major killer of women in this country it is reasonable to say that avoidance of pesticide residues in food (the only known route of exposure to DDT in this country, since we no longer use it to spray for mosquitoes) could save numerous lives and reduce our health care cost dramatically.

After 50 years of "Better Living Through Chemistry" scientists have finally shown that breast cancer is associated with pesticide residue, They have yet to prove that it causes numerous other maladies. I am not waiting for them to prove it before I change my eating habits. As a clinician who sees numerous environmentally poisoned people with health problems, I am convinced of an association between chemicals and disease. The biggest source of exposure for many people is their workplace, then their homes, followed by air, food and water. Of these the easiest to control are our home environment and our diet.

Eating organic food, drinking pure water, and watching our airborne chemical exposure can have profound effects on our health. My friend Steve, who has now gone through an extensive protocol to remove the pesticide residue from his body and had regained his health, will back me up on that. When he added up the costs of his illness in time off work and medical expenses, he found that eating organic food was much less expensive than eating non-organic foods. He is eating better foods now, and my organic garden continues to grow, along with my children.

Walter J. Crinnion N.D., is a Naturopathic Physician in Bellevue, Washington. He is a faculty member at Bastyr University in Seattle, where he teaches Environmental Toxicity, and Clinical Ecology. He is also adjunct faculty at Southwest College of Naturopathic Medicine, where he teaches an intensive class on Environmental Medicine. Since 1987, Dr. Crinnion has operated the most comprehensive cleansing protocol in the nation.

Article Source: http://lookwayup.com

Top Ten Foods to Eat Organically

Excerpted from Your Organic Kitchen by Jesse Ziff Cool

You can sidestep harm and still eat vitamin-rich foods. If you cannot find these foods organically, here are some great alternatives that contain the same valuable vitamins and minerals.

High-Pesticide Food: Strawberries
Main Nutrient: Vitamin C
Healthy Alternatives: Blueberries, raspberries, oranges, grapefruit, kiwifruit, watermelon

High-Pesticide`Food: Bell peppers
Main Nutrient: Vitamin C
Healthy Alternatives: Green peas, broccoli, romaine, lettuce

High-Pesticide Food: Spinach
Main Nutrient: Vitamins A and C
Healthy Alternatives: Broccoli, Brussels sprouts, asparagus

High-Pesticide Food: Cherries
Main Nutrient: Vitamin C
Healthy Alternatives: Oranges, blueberries, raspberries, kiwifruit, blackberries, grapefruit

High-Pesticide Food: Peaches
Main Nutrient: Vitamins A and C
Healthy Alternatives: Nectarines, watermelon, tangerines, oranges, grapefruit

High-Pesticide Food: Mexican cantaloupe
Main Nutrient: Vitamins A and C
and potassium Healthy Alternatives: U.S. cantaloupe grown from May to December, watermelon

High-Pesticide Food: Celery
Main Nutrient: Carotenoids
Healthy Alternatives: Carrots, broccoli, radishes, romaine lettuce

High-Pesticide Food: Apples
Main Nutrient: Vitamin C
Healthy Alternatives: Watermelon, nectarines, bananas, tangerines

High-Pesticide Food: Apricots
Main Nutrient: Vitamins A an C and potassium
Healthy Alternatives: Nectarines, watermelon, oranges, tangerines

High-Pesticide Food: Green beans
Main Nutrient: Potassium

By : Alternative Medicine Direct

Read More.....

Lung Cancer Disease

What is Lung Cancer?



Also called: Bronchogenic carcinoma

Lung cancer is a malignant (cancerous) tumor that starts from cells of the lung.

The lungs are a pair of sponge-like organs found in the chest that take in oxygen when we breathe in and get rid of carbon dioxide when we breathe out. The right lung is a bit larger than the left lung, which is smaller to accommodate for the size of the heart on the left side of the body. The right lung has three sections, called lobes, and the left lung has two.

Lung cancer is the rapid growth of abnormal cells in the lung. It can start anywhere in the lungs and affect any part of the respiratory system.

Lung cancer is the leading cause of cancer deaths in both men and women. Fewer than half of the people who develop lung cancer live 1 more year. And only 15% of people who develop lung cancer live for 5 more years.

Type of Lung Cancer



Lung cancer is commonly divided into two types:

1. Small Cell Lung Cancer (SCLC). Small cell lung cancer spreads early in the course of the disease and occurs almost exclusively in smokers. Surgical removal usually isn't an option for this type of cancer; instead, it's best treated with chemotherapy and radiation. Even so, the five-year survival rate for small cell lung cancer is very low.

• Non-Small Cell Lung Cancer (NSCLC). Non-small cell lung cancer, which is more common, accounts for more than 75 percent of lung cancers. If caught early when it's confined to a small area, it often can be removed surgically. There are four major categories of non-small cell lung cancer:
• Squamous cell carcinoma: is a cancer that begins in squamous cells, which are thin, flat cells found in the passages of the respiratory and digestive tracts as well as in the surface of the skin and the lining of the hollow organs of the body. This type of NSCLC is linked to a history of smoking and usually found centrally, near a bronchus. It is also called epidermoid carcinoma. This cancer forms in cells lining the airways. It's the most common type in men.
• Adenocarcinoma: This type of cancer usually begins in the mucous-producing cells of the lung. It's the most common type in women and in people who have never smoked or were exposed to secondhand smoke.
• Large cell carcinoma: is a type of lung cancer in which the cells are large and look abnormal when viewed under a microscope. It can be found in any part of the lung and tends to grow and spread rapidly. This type of cancer originates in the peripheral part of the lungs.
• Bronchoaveolar carcinoma: This uncommon type of non-small cell lung cancer tends to grow more slowly than other forms of the disease. It occurs more often in smokers than in nonsmokers and tends to arise in more than one location at the same time.

What causes lung cancer?

Although smoking is by far the leading risk factor for lung cancer, it is known that there are several other risk factors linked to the disease. Some of the risk factors for lung cancer are discussed below:

1. Smoking

Tobacco smoking is believed to be responsible for 80 percent of all cases of lung cancer. The risk of lung cancer increases with the length of time a person has been smoking, the number of packs per day smoked, and how deeply the smoke is inhaled. However, if a person quits smoking before lung cancer develops, the lung tissue slowly returns to normal, which lowers the risk of lung cancer.

Some people think that smoking cigars and pipes is less harmful than smoking cigarettes. However, research has shown that cigar and pipe smoking are almost as likely to cause lung cancer as cigarette smoking. Even cigar and pipe smokers who do not inhale are at increased risk for lung, mouth and other types of cancers.

Secondhand smoke, also called environmental tobacco smoke, describes the smoke in the air when someone else smokes. Exposure to secondhand smoke is called involuntary or passive smoking and increases lung cancer risk. For example, nonsmoking spouses of smokers and people exposed to tobacco smoke in the workplace are more likely to get lung cancer.

2. Asbestos

Asbestos is any of several minerals that occur naturally as fibers. These fibers tend to break easily into particles, which can float in the air and become inhaled, where they can lodge in the lungs, damaging cells and increasing the risk for lung cancer. Formerly used as fireproof insulating materials, asbestos is rarely used today in the workplace or in home products, as it has since been implicated as a cause of certain cancers.

Workers who have been exposed to large amounts of asbestos — such as those in industries like shipbuilding, insulation work, and asbestos mining and manufacturing — have a higher risk of getting lung cancer. The risk of lung cancer is even higher among asbestos workers who also smoke.

3. Radon

Radon is an invisible, odorless and tasteless radioactive gas that occurs naturally in soil and rock. It can cause damage to the lungs that may lead to lung cancer. People who work in mines may be exposed to radon; occasionally, radon can also accumulate indoors. Radon levels in homes may be measured by a kit found in most hardware stores.

4. Marijuana

Many of the carcinogens found in tobacco are also found in marijuana, which actually has more tar than regular cigarettes. Research suggests that marijuana may also cause cancers of the mouth and throat.

5. Lung diseases

Certain lung diseases, such as tuberculosis and some types of pneumonia, often leave scars on the lung that can increase the risk of developing lung cancer.

6. Personal and family history

A person who has had lung cancer once is at increased risk for developing a second lung cancer. Siblings and children of people who have had lung cancer may also have a slightly higher risk.

What are the symptoms of lung cancer?

Because most lung cancers do not cause any symptoms until they have spread, only about 15 percent of lung cancers are found in the early stages. When lung cancer is found early, it is often as a result of a chest X-ray, CT scan or other test that was being done for another reason. Symptoms of lung cancer may include:

• A cough that does not go away and gets worse over time.
• Constant chest pain, often made worse by deep breathing.
• Hoarseness.
• Weight loss and loss of appetite.
• Coughing up blood.
• Shortness of breath.
• Recurring infections such as bronchitis and pneumonia.
• New onset of wheezing.
• Swelling of the neck and face.
  

Remember that these symptoms may be caused by conditions other than lung cancer. It is important to check with a doctor.

Diagnostic Tests for Lung Cancer:



If there is any reason to suspect lung cancer, the doctor will take a medical history and conduct a physical exam. The doctor may also order a chest X-ray and other tests. If lung cancer is suspected, sputum cytology (the microscopic examination of cells obtained from a deep-cough sample of mucus in the lungs) is a simple test that may be useful in detecting lung cancer.

To confirm the presence of lung cancer, the doctor must examine tissue from the lung. A biopsy — the removal of a small sample of tissue for examination under a microscope by a pathologist — can show whether a person has cancer. A number of procedures may be used to obtain this tissue:

* Bronchoscopy: The doctor puts a bronchoscope (a thin, lighted tube) into the mouth or nose and down through the windpipe and into the bronchi. This test can help find tumors or it can be used to take samples of tissue or fluids to see if cancer cells are present.

* Needle aspiration: A needle is inserted through the chest into the tumor to remove a sample of tissue.

* Thoracentesis: Using a needle, the doctor removes a sample of the fluid that surrounds the lungs. This test is done to check whether fluid around the lungs is caused by cancer or by a benign condition such as heart failure or an infection.

* Thoracotomy: Surgery to open the chest is sometimes needed to diagnose lung cancer. This procedure is a major operation performed in a hospital.

If the diagnosis is cancer, the doctor will conduct additional tests to determine the stage (or extent) of the disease (stages of lung cancer are discussed later). Some tests used to determine the cancer stage include:

* Computed tomography (CT) scan: A CT scan is an X-ray procedure in which the X-ray beam moves around the body, taking pictures from different angles. These images are combined by a computer to produce a detailed cross-sectional picture of the inside of the body.

* Magnetic resonance imaging (MRI): MRI uses large magnets and radio waves to produce computer-generated cross-sectional pictures of internal organs.

* Radionuclide scanning: Scanning can show whether cancer has spread to other organs, such as the liver. The patient swallows or receives an injection of a mildly radioactive substance. A machine (scanner) measures and records the level of radioactivity in certain organs to reveal abnormal areas.

* Bone scan: A bone scan is a type of radionuclide scanning that can show whether cancer has spread to the bones.

* Mediastinoscopy: A mediastinoscopy can help show whether the cancer has spread to the lymph nodes in the chest. With the patient asleep, tissue samples are taken from the lymph nodes along the windpipe through a small hole cut into the neck. Examining the tissue under a microscope can show if cancer cells are present.

* Bone marrow biopsy: A needle is used to remove a small piece of bone, usually from the back of the hipbone, and the sample is checked for cancer cells.

* Blood tests: Certain blood tests are often done to help see if the lung cancer has spread to the liver or bones.

Lung Cancer Treatment

Lung cancer treatment depends on the type and stage of cancer, as well as the overall health of the patient.

Treatment may include surgery to remove the cancer, radiation therapy, or medications (chemotherapy). Treatment for non–small and small cell cancer may be different.

Lung cancer treatment may include one or more of the following therapies:

1. Surgery

Surgery is taking out the cancer. Surgery is the most effective treatment for early-stage non–small cell lung cancers (stages I and II). In some cases, only the portion of the lung that contains the tumor is removed. In others, one lobe or even the entire lung may be taken. Surgery to remove all or part of a lung often involves opening one side of the chest, a procedure called a thoracotomy.

Operations to treat lung cancer include:

• Wedge resection: In this operation, the doctor removes only the section of the lung that contains the tumor along with a margin of normal tissue.
• Lobectomy: The most common type of surgery, lobectomy involves removing an entire lobe of one lung.
• Pneumonectomy: In this operation, an entire lung is removed. Because pneumonectomy will decrease lung function considerably, as well as lead to other complications, it's performed only when absolutely necessary and then only if the patient breathing capacity is sufficient to allow breathing with a single lung.
  

Lung function studies and a lung scan are often done before surgery to predict whether the patient will have enough remaining lung function after surgery to live a fairly normal life.

2. Radiation therapy

Radiation therapy uses high-dose X-rays to kill cancer cells. Radiation therapy is often used in combination with surgery or chemotherapy or both. Radiation following surgery for stages IIA, IIB, and IIIA (with lymph node involvement) may reduce the risk of cancer returning in the chest.

The way in which radiation is delivered depends on the type and stage of the cancer being treated. Radiation therapy may be given before, during or after chemotherapy. In all cases, however, the goal of treatment is to destroy cancer cells while harming as little normal tissue as possible.

Small cell lung cancer often spreads to the brain. For that reason, the doctor may sometimes recommend brain radiation therapy to prevent cancer from metastasizing to that part of the body or to eliminate micrometastases that aren't yet detectable with imaging studies. Brain radiation therapy can cause short-term memory problems, fatigue, nausea and other serious side effects.

3. Chemotherapy

Because most small cell lung cancers have spread beyond the lungs by the time they're discovered, an operation usually isn't a treatment option. Instead the most effective treatment is chemotherapy, either alone or in combination with radiation therapy.

Chemotherapy uses medications or drugs to kill cancer cells. Chemotherapy is the most effective treatment for small cell lung cancer, but it is only a cure in a small number of people. Chemotherapy has been shown to improve survival in non-small lung cancer when it is given after surgery for stages IB, IIA, IIB, and IIIA. It may also be used to treat more advanced stages (stages III and IV) of non–small cell lung cancer.

In cases of small cell lung cancer, chemotherapy may be used to shrink the cancer, to slow the cancer's growth, to prevent it from spreading further, or to relieve symptoms and make the patient more comfortable (palliative care). A combination of drugs usually is given in a series of treatments over a period of weeks or months, with breaks in between so that the body can recover. Even so, because the drugs damage healthy cells along with malignant ones, they can cause serious side effects.

4. Targeted therapy

Targeted therapies use medications or antibodies to block growth factors that allow some cancers to grow. At this time, targeted therapies are used for advanced stages.

resource: Cancer Info Guide

Staging of Lung Cancer:

TNM staging is a process to measure how advanced the cancer is. The following three factors are considered:

* Tumor - size and location
* Node - lymph node involvement
* Metastasis - has the cancer spread

1. Small cell lung cancer staging:

Limited stage : The cancer is only in one lung and in lymph nodes on the same side of the chest.

Extensive stage : The cancer has spread to the other lung, to lymph nodes on the other side of the chest, or to distant organs. Many doctors consider cancer that has spread to the fluid around the lung to be extensive stage as well.

2. Non-small cell lung cancer staging:

Stage 0 : The cancer is limited to the lung and is found in a few layers of cells only. It has not grown through the top lining of the lung. Stage 0 is also called carcinoma in situ.

Stage : The cancer is in the lung only, with normal tissue around the tumor. Stage I is divided into stages IA and IB, based on the size of the tumor.

Stage II : The cancer has spread to nearby lymph nodes or to the chest wall (the ribs and muscles that make up the area of the body between the neck and abdomen); the diaphragm (thin muscle below the lungs and heart that separates the chest from the abdomen); the mediastinal pleura (thin membrane that covers the outside of the lungs in the area near the heart); or the parietal pericardium (outer layer of tissue that surrounds the heart). Stage II is divided into stage IIA and stage IIB, based on the size of the tumor and whether it has spread to the lymph nodes.

Stage III : The cancer has either:
* Spread to the lymph nodes in the mediastinum (middle area between the lungs that contains the heart, major blood vessels and other structures);or
* Spread to the lymph nodes on the opposite side of the chest or in the lower neck.

Stage III is divided into stage IIIA (which is sometimes treated with surgery) and stage IIIB (which is rarely treated with surgery).

Stage IV : The cancer has spread to other parts of the body or to another lobe of the lungs.

Resource:
National Cancer Institute
MEDLINEplus Health Information
CancerGuide

Read More.....

Asbestosis - Pulmonary Asbestosis Disease

What is Asbestosis?

Asbestosis is a chronic inflammatory lung disease that occurs due to long- term exposure to asbestos fibres .

Asbestosis is a breathing disorder caused by inhaling asbestos fibers. Prolonged accumulation of these fibers in your lungs can lead to scarring of lung tissue and diminished breathing capacity. Because many other diseases also lead to lung scarring, other causes must be excluded first when a patient is found to have lung scarring (pulmonary fibrosis).

Asbestosis particularly affects the parenchymatous tissues of the lungs and has gained increased significance due to its link to mesothelioma and to other forms of lung and laryngeal cancer. Asbestosis is also frequently associated with Chronic Obstructive Pulmonary Disease (COPD).

Asbestosis, as a medical problem, was recognized early in the 20th century. A few decades later studies established asbestosis as a predisposing factor for bronchogenic carcinoma and malignant mesothelioma. The developed countries have started recognizing the harmful effects of asbestos and have replaced it with synthetic metal fibres. Legislations have been passed globally to curtail its use in industries.

Patients with particular x-ray findings or biopsy results must also have a remote history of asbestos exposure and a characteristically delayed development of the condition in considering asbestosis as a diagnosis. Smoking appears to increase the frequency and/or the rate of progression of asbestosis, possibly by preventing the efficient elimination of inhaled fibers from the airways.

What are symptoms and signs of asbestosis?

The clinical symptoms usually include slowly progressing shortness of breath and cough, often 20 to 40 years after exposure to asbestos. Breathlessness advances throughout the disease, even without further asbestos inhalation. In the absence of cigarette smoking, sputum (mucus coughed up from the lungs) production and wheezing are uncommon. The exception is workers who have been exposed to very high concentrations of asbestos fibers. Those workers may also develop symptoms as soon as 10 years after exposure. Other indications of asbestosis include abnormal lung sounds on examination, changes in the ends of the fingers and toes ("clubbing"), a blue tinge to the fingers or lips ("cyanosis"), and failure of the right side of the heart ("cor pulmonale"). Asbestosis can be a progressive disease even after exposure to asbestos has stopped.

Signs and symptoms develop when damage and scarring caused by the asbestos fibers lead to stiffness in your lung tissue so that your lungs can't contract and expand normally (a form of pulmonary fibrosis). Once exposure to asbestos is stopped, however, the fibrosis does not progress.

Some asbestosis symptoms include:

* Shortness of breath, initially only with exertion, but eventually even while resting
* Decreased tolerance for physical activity
* Coughing
* Chest pain
* Finger clubbing in some cases

Although most of these signs and symptoms are similar to those of other breathing disorders, such as asthma, the way in which they develop is different. In asbestosis the effects of the disease are insidious, occurring over months and years.

Diagnosing Asbestosis





The diagnosis of asbestosis is made when there is a history of asbestos exposure and positive results from a clinical exam. There is a well-defined latency period of approximately 20 years or more between the initial exposure to asbestos and the development of asbestos related calcification and scarring.

Asbestosis can be diagnosed by the following tests:

• Chest X-ray- irregular opacities in the lower lobes, heart border becomes shaggy. In the late stages of disease, there is a honey-comb likeness and volume loss. X rays can show shadows or spots on the lungs or an indistinct or shaggy outline of the heart that suggests the presence of asbestosis.
• CT scan- scarring and thickening can be seen on the chest x-ray and CT, but the CT scan can detect calcifications around the lung (typical of asbestosis) more often. It is considered the most accurate means for detecting asbestos related abnormalities.
• PFTs- pulmonary function testing is used to test for loss of lung volume, and for the impairment of movement of oxygen across the air sacs. Pulmonary function tests can be used to assess a patient's ability to inhale and exhale, and a computed tomography scan (CT) of the lungs can show flat, raised patches associated with advanced asbestosis.
• Blood tests are used to measure concentrations of oxygen and carbon dioxide.

Complications

The severity of asbestosis is generally related to the amount and duration of exposure to asbestos. Effects of the disease may be so mild as to cause almost no symptoms. Or the condition may create such a reduced flow of oxygen as to be disabling or even fatal. Asbestosis may lead to the following conditions:

• High blood pressure in your lungs. Asbestosis-related scar tissue may eventually compress or obliterate your lungs' small blood vessels, causing high blood pressure in your lungs' arteries (pulmonary hypertension).
• Heart problems. Pulmonary hypertension can lead to enlargement and failure of your heart's right ventricle (cor pulmonale). Your heart consists of four chambers — two upper chambers called atria and two lower chambers called ventricles. Your right ventricle assists in pumping oxygen-poor blood from your organs and tissues to your lungs, where your blood receives a new boost of oxygen. As your pulmonary arteries narrow, your heart's right ventricle must work harder to pump blood through the lungs. Initially, the heart tries to compensate by thickening its walls and dilating the right ventricle to increase the amount of blood it can hold. But this measure only works temporarily, and eventually — after a period of a few years — the right ventricle weakens and fails from the extra strain.
• Lung cancer. If you smoke and have asbestosis, your chances of developing lung cancer increase greatly, especially if you smoke more than a pack a day. Tobacco smoke and asbestos both contribute to each other's cancer-causing (carcinogenic) effects, so that the combination of both risk factors together is more dangerous than the effects of either risk factor alone.
• Other lung damage. Exposure to asbestos can lead to other health complications including changes in the thin membranes covering your lungs and lining your chest cavity (pleural membranes). Pleural changes may be the first signs of asbestos exposure and may include pleural thickening, the formation of calcium deposits in the pleura (plaques), and an abnormal accumulation of fluid between the membranes (pleural effusion). Pleural effusion itself is benign and doesn't increase your risk of asbestosis or malignant mesothelioma.
• Other cancer. Prolonged exposure — 20 years or more — to asbestos can also lead to malignant mesothelioma. Diagnosis and treatment of this cancer is often difficult. Malignant mesothelioma may occur even many years after exposure has stopped.
  

How is asbestosis treated?

Patients with asbestosis, like others with chronic lung disease, are at a higher risk of serious infection, low oxygen levels in the blood, and heart failure. These patients also may not recover as quickly from viral and bacterial infections. In addition, they may be at increased risk for certain fungal and unusual infections that take advantage of diseased or scarred lung tissue. The medical management of these patients should focus special attention on preventing and rapidly treating these infections. Flu and pneumococcal vaccinations are a part of routine care for these patients. There is, however, no treatment or cure for asbestosis. In particular, steroid and immune-based therapies have not been shown to benefit these patients.

There's no treatment to reverse the effects of asbestos on the alveoli. Treatment focuses on preventing progression of the disease and relieving symptoms. The most important factor in keeping the condition from worsening is to eliminate exposure to asbestos. For most people, scarring of lung tissue doesn't begin or progress once exposure has ended.

The following may be components of asbestosis treatment:

• Smoking cessation. If you smoke, it's important to stop, particularly because of the extremely heightened risk of lung cancer. In addition, smoking may cause emphysema, which further reduces your lung reserves.
• Vaccinations. Because of your impaired lung condition, treat a cold or a bout of the flu promptly to avoid complications. Your doctor may advise you to receive flu and pneumonia vaccines.
• Medications. The complication of pulmonary hypertension is often treated with medications to expand or relax blood vessels, and blood-thinning medications to prevent blood clots from forming and obstructing narrowed vessels.
  

To ease difficulty breathing, your doctor may prescribe supplemental oxygen or drain fluid from around your lungs, if necessary. Occasionally, severe cases of asbestosis may be treated with lung transplantation.

© 1998-2008 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved. A single copy of these materials may be reprinted for noncommercial personal use only. "Mayo," "Mayo Clinic," "MayoClinic.com," "Mayo Clinic Health Information," "Reliable information for a healthier life" and the triple-shield Mayo logo are trademarks of Mayo Foundation for Medical Education and Research. Terms of Use.

Read More.....

Asbestos Disease | Types of Asbestos Disease

Asbestosis scaring of the lung tissue Mesothelioma nodular cancer of the plural lining of the lung Lung Cancer Note: smoking greatly increases risk - 50 to 90 times

The most common forms of asbestos disease are pleural plaques, asbestosis, lung cancer, and mesothelioma.

Asbestosis

Asbestosis is a disease which is characterized by pulmonary fibrosis, a progressive scarring of the lungs caused by the accumulation of asbestos fibers. Asbestosis is associated exclusively with chronic, occupational exposure. The build up of scar tissue interferes with oxygen uptake through the lungs and can lead to respiratory and heart failure. Often, asbestosis is a progressive disease, even in the absence of continued exposure. Symptoms include shortness of breath, cough, fatigue, and vague feelings of sickness. When the fibrosis worsens, shortness of breath occurs even at rest.

Pleural Plaques

Pleural plaques and pleural calcification are markers of exposure and may develop 10 to 20 years after initial exposure. Plaques are opaque patches visible on chest x-rays that consist of dense strands of connective tissue surrounded by cells. All commercial types of asbestos induce plaques. Plaques can occur even when fibrosis is absent and do not seem to reflect the severity of pulmonary disease.

Lung Cancer

Of all the diseases related to asbestos exposure, lung cancer has been responsible for over half of the excess deaths resulting from occupational exposure. Although tissues and cells react to the presence of asbestos immediately, detectable symptoms take years, or more often decades, to manifest themselves. Asbestos-induced lung cancer may not show up on x-rays for twenty years or more after the exposure began. This delay between exposure and onset is referred to as the "latency period". Even in cases of prolonged heavy exposure, abnormalities commonly appear on x-rays only after ten or more years following exposure.

Mesothelioma

Mesothelioma is rare or nonexistent in non-asbestos exposed populations but is becoming more common among asbestos-exposed individuals.

Mesothelioma is a cancer of the lining of the lungs and not a cancer that occurs inside the lung. Mesothelioma causes the cells of the mesothelium to become abnormal and infinitely reproduce.

A normal mesothelium cell (or any cell for that matter) can only reproduce a certain amount of times. This keeps certain cells from invading other cells. Cancer occurs when those cells become mutated and their limits are removed, allowing them to reproduce uncontrollably. These abnormal cells then form a lump that is known as a tumor. In a benign tumor the abnormal cells do not spread into surrounding areas, but malignant tumors do have the ability to spread. If the tumor is left untreated then it may spread and destroy the neighboring tissue. Sometimes cells can even break off the original tumor and spread to other organs and tissue through the bloodstream or the lympathic system. The lympathic system is part of the immune system. It is a complex system that includes the bone marrow, the thymus and the spleen, and lymph nodes throughout the body that are connected by a network of lympathic vessels. When the cancer cells reach a new site they may continue to divide and form a new tumor, which is referred to as a secondary tumor or a metastasis.

Mesothelial cells line the chest cavity, the abdominal cavity, and the cavity around the heart. They also cover the outer surface of most internal organs. The tissue that is formed by these mesothelial cells is called mesothelium. Mesothelium helps protect the organs by producing a lubricating fluid that lets organs move around. This fluid makes it easier for the lungs to expand and move around inside the chest during breathing. The mesothelium in the chest is called the pleura and the mesothelium around the abdomen is known as the peritoneum. The mesothelium around the heart (or the pericardial cavity, a sac like space around the heart) is called the pericardium.

The asbestos disease mesothelioma has a long latency period, where it is present but not evident or active. The disease can lie dormant for ten to sixty years after being exposed to asbestos. Because of this, it is often hard to determine the cause of mesothelioma.

Read More.....

Asbestos Exposure - How is Expose and Affect for Health?

What is Asbestos?



Asbestos is the common name for any variety of silicate materials that are fibrous in structure and are more resistant to acid and fire than other materials. It has two forms, serpentine and amphibole, and is made of impure magnesium silicate. Asbestos is used for thermal insulation, fire proofing, electrical insulation, building materials, brake linings and has been used in numerous industries.

There are six different minerals commercially available that can make up "asbestos exposure", including:

1. chrysotile,or white asbestos;
2. amosite,which usually has brown fibers;
3. crocidolite,or blue asbestos;
4. tremolite,
5. anthophyllite, which usually has gray fibers
6. actinolite.

Of these differerence minerals, chrysotile and amosite are most often used.

Asbestos is a potent carcinogen, that is, a cancer-causing substance, and is a serious health hazard. It is the known cause of pleural plaques, asbestosis, mesothelioma, and causes cancers of the lung, esophagus, and colon. Diseases caused by asbestos have a long latency period, usually taking ten to forty years before showing any symptoms of the disease. This is especially apparent today, when people who worked with installing asbestos as insulation and other materials in the 1970s are just now coming to realize that they are developing cancer at alarming rates.

Asbestos Exposure in My Home

The U.S. Environmental Protection Agency provides information in its website about possible locations in the home where asbestos hazards may be found9:

1. Some roofing and siding shingles are made of asbestos cement.
2. Houses built between 1930 and 1950 may have asbestos as insulation.
3. Asbestos may be present in textured paint and patching compounds used on wall and ceiling joints. Their use was banned in 1977.
4. Artificial ashes and embers sold for use in gas-fired fireplaces may contain asbestos.
5. Older products such as stove-top pads may have some asbestos compounds.
6. Walls and floors around wood burning stoves may be protected with asbestos paper, millboard, or cement sheets.
7. Asbestos is found in some vinyl floor tiles and the backing on vinyl sheet flooring and adhesives.
8. Hot water and steam pipes in older houses may be coated with an asbestos material or covered with an asbestos blanket or tape.
9. Oil and coal furnaces and door gaskets may have asbestos insulation.




How might I be exposed to asbestos?

We are all exposed to low levels of asbestos in the air we breathe. These levels range from 0.00001 to 0.0001 fibers per milliliter of air and generally are highest in cities and industrial areas.

People working in industries that make or use asbestos products or who are involved in asbestos mining may be exposed to high levels of asbestos. People living near these industries may also be exposed to high levels of asbestos in air.

Asbestos fibers may be released into the air by the disturbance of asbestos-containing material during product use, demolition work, building or home maintenance, repair, and remodeling. In general, exposure may occur only when the asbestos-containing material is disturbed in some way to release particles and fibers into the air.

Drinking water may contain asbestos from natural sources or from asbestos-containing cement pipes.
top

How can asbestos affect my health?

Asbestos mainly affects the lungs and the membrane that surrounds the lungs. Breathing high levels of asbestos fibers for a long time may result in scar-like tissue in the lungs and in the pleural membrane (lining) that surrounds the lung. This disease is called asbestosis and is usually found in workers exposed to asbestos, but not in the general public. People with asbestosis have difficulty breathing, often a cough, and in severe cases heart enlargement. Asbestosis is a serious disease and can eventually lead to disability and death.

Breathing lower levels of asbestos may result in changes called plaques in the pleural membranes. Pleural plaques can occur in workers and sometimes in people living in areas with high environmental levels of asbestos. Effects on breathing from pleural plaques alone are not usually serious, but higher exposure can lead to a thickening of the pleural membrane that may restrict breathing.
top

How likely is asbestos exposure to cause cancer?

The Department of Health and Human Services (DHHS), the World Health Organization (WHO), and the EPA have determined that asbestos is a human carcinogen.

It is known that breathing asbestos can increase the risk of cancer in people. There are two types of cancer caused by exposure to asbestos: lung cancer and mesothelioma. Mesothelioma is a cancer of the thin lining surrounding the lung (pleural membrane) or abdominal cavity (the peritoneum). Cancer from asbestos does not develop immediately, but shows up after a number of years. Studies of workers also suggest that breathing asbestos can increase chances of getting cancer in other parts of the body (stomach, intestines, esophagus, pancreas, and kidneys), but this is less certain. Early identification and treatment of any cancer can increase an individual's quality of life and survival.

Cigarette smoke and asbestos together significantly increase your chances of getting lung cancer. Therefore, if you have been exposed to asbestos you should stop smoking. This may be the most important action that you can take to improve your health and decrease your risk of cancer.

Is there a medical test to show whether I've been exposed to asbestos?

Low levels of asbestos fibers can be measured in urine, feces, mucus, or lung washings of the general public. Higher than average levels of asbestos fibers in tissue can confirm exposure but not determine whether you will experience any health effects.

A thorough history, physical exam, and diagnostic tests are needed to evaluate asbestos-related disease. Chest x-rays are the best screening tool to identify lung changes resulting from asbestos exposure. Lung function tests and CAT scans also assist in the diagnosis of asbestos-related disease.

References
Agency for Toxic Substances and Disease Registry (ATSDR). 2001. Toxicological Profile for Asbestos. Update. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Read More.....