Monday, August 3, 2009

What do you know about mesothelioma?

How many people do you know who have mesothelioma? The annual incidence of mesothelioma in the U.S. is approximately 3300 new cases per year. Fortunately, the incidence is declining because we've done a better job to control for asbestos exposure. However, many people live with a long history of asbestos exposure because of certain types of occupations.

From a public health standpoint, mesothelioma is a significant health burden because mesothelioma prognosis is often quite poor. The median survival of patients with mesothelioma is between 6 and 18 months. Considering that advances in modern medicine have not significantly improved survival, we're faced with an illness that we still can't treat very effectively. Mesothelioma is often classified into three broad histologic subtypes:

1. epithelioid,
2. sarcomatoid, and
3. biphasic (mixed)

Mesothelioma doesn't just occur in the chest. There are other forms, such as peritoneal mesothelioma that occurs in the abdominal space. This type often rapidly spreads within the abdomen and is causes problems as the disease affects abdominal organs. So what types of treatments are currently available? You have surgery, radiation, chemotherapy, and a variety of combinations. Recently, investigators have also been exploring the role of gene therapy. That's the area that I find most fascinating because we may potentially see some novel treatment approaches that combine gene expression profiling and prognostication. By engineering viruses to carry certain genes. For instance, the administration of AdHSVtk could transduce the tumor cells, enabling them to express viral thymidine kinase, and thus make them sensitive to the normally nontoxic antiviral drug ganciclovir. This type of bioengineering research sounds very interesting to me.

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