What is cancer insurance? The concept of cancer insurance is rather simple. When, benefits are offered directly to a cancer patient, so that the patient can pay off the extra costs involved in cancer treatment, this is known as cancer insurance. In most cases; however, there need to be medical proof which verifies that a person in question is diagnosed with cancer, to get the cancer insurance.The most important cause of the increased mortality rates among people of all age groups has been identified to be cancer. The risk of being cancer patient increases with age, according to the statistics of American Cancer Society.The medicines required to treat cancer, and therapies such as radio and chemo therapies as well as the surgeries that a cancer patient would need to undergo, all add up to a large expense. Therefore, a large amount of financial support will be required when treating cancer. The overall expenditure when treating cancer in United States for the year 2007 was estimated by the national institute of health- to be approximately $219.2 billion, of which, $89 billion was medical costs. Therefore, though a person might have a normal health insurance that could cover the expenses of day to day medical requirements and in case of accidents; it is doubtful whether those insurances can cover the high costs of cancer treatments. Hence, considering cancer insurance is of utter most importance for cancer patients.However, other than one specific cancer insurance, there are various other different ways in which cancer patients can insurance themselves, such as private health insurances and government funded insurance plans such as in the US- Medicare and Medicaid).Also, for cancer patients there are other financial resources available through government programs, disability benefits, aid from voluntary organizations, and living benefits from life insurance policies.There are certain points to consider before purchasing cancer insurance. First you need to find out what coverage is available under your present health care policy – in the case that you are diagnosed with cancer. If you are on Medicaid or some other government funded insurance plan, reconsider whether you actually need cancer insurance.Once you are certain about purchasing cancer insurance, consider about the best cancer policy that meets your requirements at the most affordable price for you; however, make it a point to read and understand the cancer policies thoroughly.Make sure to find out what are covered by the cancer policy and what are not, as well as whether there is any coverage for other diseases that could occur as a result of the cancer or its treatment- and whether benefits of other health insurance policies will be affected by the one you are considering to purchase.Choosing a cancer insurance that is best suited, if done wisely, would be the best way of ensuring financial support for a cancer patient.

The heavier and long time exposure to asbestos increases the risk of asbestos-related sickness. People who work with asbestos wear non-public shielding plant to lower their risk of exposure. There are some cases in which, not all staff that is heavily exposed develops asbestos-related illnesses.

For cancer patients, diet is typically an overlooked subject. But eating the right nutritive foods for health, strength and energy is just as critical as taking the right drugs. Mesothelioma patients undergoing treatment must follow a special cancer diet made by their diet experts. Cancer diets involve eating the correct amounts of protein and calories and drinking the right quantity of water to keep the hurting body replenished and energized. At some time during our childhood we’ve all been told to eat our plants. The body wishes heaps of nourishment when it is going through chemical treatment or perhaps when the patient is taking certain drugs.

The patients that are undergoing mesothelioma treatment may select not to eat thanks to the worrying complications they may experience. Other complications of mesothelioma treatment include revulsion, puking, and dry mouth, a change in the sense of smell or taste, and / or constipation. On the other hand, not all staff that is heavily exposed develops asbestos-related sicknesses. This risk could be the result of exposure to asbestos dust brought home on the clothing and hair of asbestos workers. To reduce the possibility of exposing relations to asbestos fibers, asbestos staff is typically wanted to rain and change their clothing before leaving the workplace.

The Kent brand of cigarettes used asbestos in its filters for the initial few years of production in the 1950s and some cases of mesothelioma have resulted. Smoking current cigarettes does not appear to increase the danger of mesothelioma. Close monitoring (routine X-rays or pleural biopsy) for mesothelioma is remitted. Oxygen care at home is commonly needed to relieve the shortness of breath.

The separate T, N and M stages are combined under the TNM staging system to provide a single stage designation that expressly considers the tumor size and spread, lymph node involvement and metastasis to other organs of the body. The system is valuable because each of these factors can have a significant impact on the patient’s prognosis.

Stage I (T1, N0, M0)

Mesothelioma involves either the right or left pleura lining the chest. It has only spread to the outer lining of the lung in, at most, a few small spots. It has not spread to the lymph nodes or distant sites.

Stage II (T2, N0, M0)

Mesothelioma involves either the right or left pleura lining the chest and has spread from the lining of the chest into

(i)                  the outer lining of the lung

(ii)                the diaphragm

(iii)               into the lung itself. It has not spread to the lymph nodes or distant sites.

Stage III (T1 or 2, N1 or 2, M0; OR T3, N0-2, M0)

Mesothelioma involves either the right or left pleura lining the chest and may or may not have spread from the lining of the chest into

(i)                  the outer lining of the lung

(ii)                the diaphragm

(iii)               into the lung itself and has spread to lymph nodes anywhere in the chest on the same side as the tumor, but has not spread to distant sites

OR Mesothelioma involves either the right or left pleura lining the chest and has spread into

(i)                  the first layer of the chest wall

(ii)                the fatty part of the mediastinum

(iii)               a single place in the chest wall or

(iv)              the outer covering layer of the heart and may or may not have spread to lymph nodes but not as far as to lymph nodes near the collarbone or on the opposite side of the chest. It has not spread to distant sites.

Stage IV (T4, any N, M0; OR any T, N3, M0; OR any T, any N, M1)

Mesothelioma involves either the right or left pleura lining the chest and has spread

(i)                  into the chest wall, either muscle or ribs

(ii)                through the diaphragm,

(iii)               into any organ contained in the mediastinum (esophagus, trachea, thymus, blood vessels),

(iv)              into the spine,

(v)                across to the pleura on the other side of the chest,

(vi)              through the heart lining or into the heart itself,

(vii)             into the brachial plexus (nerves leading to the arm), and may or may not have spread to lymph nodes anywhere, but has not spread to distant sites;

OR the tumor is of any size, but has spread to lymph nodes near the collarbone on either side, to hilar or mediastinal lymph nodes on the side opposite the cancerous lung but not to distant sites;

OR the mesothelioma has spread to distant sites.

TNM staging is recently developed by the International Mesothelioma Interest Group and adopted by the American Joint Committee on Cancer (AJCC)—offers a refined way to stage mesothelioma based on an analysis of the tumor (its size and how far it has spread to nearby organs), the lymph nodes, and metastasis (spread to distant organs). This information is quantified by assigning a stage to each: a tumor stage, a lymph node stage and a metastasis stage. This information is them combined in a process called stage grouping to assign a single TNM stage for the cancer described by Roman numerals from I to IV. The TNM system is similar to staging systems used for most other cancers.

Once the cancer has been assigned T, N and M stages, this information is combined—through stage grouping—to assign an overall stage of I, II, III or IV. Patients with lower stage numbers have a better prognosis and a broader range of potential treatment options.

Tumor Stages

Information about the tumor is defined by assigning a number from 1 to 4 to signal the degree of spreading of the main tumor mass in and around the pleura. The higher the T stage, the further the original tumor mass has spread to nearby structures like the chest wall, lung tissue or other areas in the chest.

T1

Mesothelioma involves either the right or left pleura lining the chest. It has only spread to the pleura covering the lung, with the exception of possibly a few other small spots.

T2

Mesothelioma involves either the right or left pleura lining the chest and has spread from the lining of the chest into

1) the outer lining of the lung,

2) the diaphragm, or

3) into the lung itself.

T3

Mesothelioma involves either the right or left pleura lining the chest and has spread into

1) the first layer of the chest wall,

2) the fatty part of the mediastinum,

3) a single place in the chest wall, or

4) the outer covering layer of the heart.

T4

Mesothelioma involves either the right or left pleura lining the chest and has spread

1) into the chest wall, either muscle or ribs,

2) through the diaphragm,

3) into any organ contained in the mediastinum (esophagus, trachea, thymus, blood vessels),

4) into the spine,

5) across to the pleura on the other side of the chest,

6) through the heart lining or into the heart itself, or

7) into the brachial plexus (nerves leading to the arm).

Node Stages

The node stage identifies the degree to which the cancer has spread to the lymph nodes. N stages range from 0 to 3, so that 0 means that mesothelioma cells have not spread to the lymph nodes at all, and larger numbers signal spread to more distant lymph nodes in the chest area.

N0

No spread to lymph nodes.

N1

Spread to lymph nodes on the same side of the chest as the mesothelioma.

N2

Spread to lymph nodes around the point where the windpipe branches into the left and right bronchi or to lymph nodes in the space behind the chest bone and in front of the heart (mediastinum). Affected lymph nodes are on the same side of the cancerous lung.

N3

Spread to lymph nodes near the collarbone on either side, to hilar or mediastinal lymph nodes on the side opposite the cancerous lung.

Metastasis Stages

The level of metastasis, or spread to other organs in the body, is communicated through the M stage. There are only two M stages to signal that mesothelioma cells have or have not spread to distant organs in the body.

M0

No spread to distant organs or areas.

M1

The cancer has spread distantly.

The Magnetic Resonance Imaging Scan is even more accurate than the CT scan. MRI scan provides extremely clear pictures. The test is especially accurate for detecting tumors in or around the lungs, and is thus often used for diagnosing mesothelioma. The MRI is particularly superior to a CT scan in discerning a tumor’s invasion through the diaphragm (the muscle below the lung cage that enables breathing) or through the mediastinum (the region in the chest between the lungs and behind the breast bone where the heart, major blood vessels, nerve tissue, and lymph glands are congregated).

MRI scans operate with radio waves and strong magnets. The energy from the radio waves is absorbed by the body and then released in a pattern that varies depending on the type of tissue or disease being studied. The pattern of radio waves given off by the tissues is translated by a computer into a very detailed image of the scanned portion of the body. The MRI not only produces cross sectional slices of the body the way a CT scanner does, it also generates slices that run parallel to the length of the body.

No preparation is required for the MRI unless the prescribing physician recommends the use of a contrast dye. In that case, the contrast-drink must be consumed prior to the test being administered. But the contrast dye is used less often for the MRI procedure than for the CT scan.

Still, MRI scans tend to be a little more uncomfortable than CT scans. For the MRI, the patient lies absolutely still on a table that moves into the tube-shaped MRI machine, which directs radio waves towards the body. The patient will hear loud clicking and other noises during the procedure, but these sounds are harmless and are no indication of a problem. Most facilities will offer earplugs to block out the noise and many will provide headphones with music to mask the noise. The procedure lasts longer than a CT scan — usually from 30 to 90 minutes. If the patient has a fear of closed-in spaces, some facilities may offer a sedative before the test. All that said many patients become so relaxed that they actually fall asleep during the test.

Computed Tomography scans are generally employed to make an initial determination that the patient does potentially have malignant mesothelioma. CT scans can also be helpful in determining the extent that the cancer may have spread.

The Computed Tomography scan is an x-ray procedure with a large doughnut-shaped machine that creates detailed cross-sectional images of the body. Instead of taking just one picture, like a traditional x-ray, a CT scanner takes several photographs as it rotates around the body. A computer then combines the pictures to make a single image of a slice of the body at a given point. The CT machine makes pictures of multiple slices of the portion of the body that is being studied. The CT scan allows technicians and doctors to create a three-dimensional image of the inside of the body.

CT scans are performed at a hospital or an outpatient facility. The scans are painless and no anesthesia is necessary. The patient lies on a table, which the technician will position in such a way as to make the most accurate pictures possible. A pillow is provided and the technician will ensure that the patient is as comfortable as possible during the procedure.

Many times, after the first pictures are taken, the patient will be given an IV (intravenous) line through which a dye or radio-contrast agent is administered to assist in outlining structures within the body. Then second round of pictures are taken. The injection may cause some patients to experience redness and a warm feeling. Occasionally, people experience allergic reactions such as hives or, rarely, difficulty breathing and low blood pressure. The doctor should be informed of any previous adverse reaction to a contrast material used for x-rays. At times, patients are asked to drink one or two pints of a contrast material solution to help in outlining the intestine.

CT scans can be more exhausting than routine x-rays because they take longer and require the patient to lie still on a table inside a ring while the scanner rotates around the body taking pictures. As with other technology, however, improvements are being made all the time to make the process faster and less tiresome.

Usually test results from a CT scan are available within a few days. The images are reviewed by a doctor who specializes in interpreting the detailed images produced by a CT scanner. The patient’s doctor will receive a summary of the specialist’s findings and will in turn explain the results with the patient.

After a diagnosis of mesothelioma is confirmed, the patient’s doctor may order additional tests to determine the extent, or “stage” of the cancer. Staging of mesothelioma is based in part on imaging studies such as chest x-rays, CT scans and MRI scans. Mesothelioma is described as localized if the cancer cells are located only on the membrane surface where the cancer originated. It is classified as advanced if the cancer has spread beyond its original site to other parts of the body, commonly the lymph nodes, chest wall, lung tissue or abdominal organs.

The treatment and outlook for patients with mesothelioma depends largely on the stage of their cancer. Unfortunately, mesothelioma often is not diagnosed until the cancer is in the late stages of development. As a result, the prognosis for the majority of patients with mesothelioma is poor. After the disease has progressed to Stage III or IV, treatment options are more limited and less effective.

Pleural mesothelioma is the only form of the disease to which a stage is assigned. Formal stages aren’t used for other types of mesothelioma because these types are rare and are not as well studied. There are four main TNM stages of pleural mesothelioma:

Stage I pleural mesothelioma is localized, meaning it is limited to one portion of the lining of the chest.

Stage II mesothelioma may have spread beyond the lining of the chest to the diaphragm or to a lung.

Stage III mesothelioma may have spread to other structures within the chest and may involve nearby lymph nodes.

Stage IV mesothelioma is an advanced cancer that has spread, or metastasized, to distant areas. Mesothelioma most commonly metastasizes to the brain, lymph nodes in the chest and areas of the lung that are away from the tumor.

Along with the TNM stage of the patient’s mesothelioma, there are additional prognostic factors that determine the mesothelioma survival rate.

Although stage is undeniably an important factor in a patient’s prognosis, it is not the only factor. Other factors should be considered as well. These factors include poor performance status—being too sick to perform normal tasks of daily life; shortness of breath; chest pain; weight loss; high white blood cell count; low red blood cell count; and high levels of a substance in the blood called LDH. These are also considered serious factors.

Overall, the five-year relative survival rate for patients with mesothelioma is approximately 10%. This means that ten percent of patients will live at least five years after their cancer is diagnosed. That figure has actually improved over the last five years. Further, recent studies show that the overall one-year survival rate is now about forty percent, a number that has also improved in the past five years. During the 1990s, it was rare for a mesothelioma patient to live more than a year after diagnosis.

Mesomark is a kind of blood test. Mesothelioma treatment is difficult because it is usually not detected until the disease has progressed to the late stages. If the disease could be detected earlier, mesothelioma patients would see an improved prognosis. Some researchers see a breakthrough in mesothelioma detection in the form of a blood test known as Mesomark. In the Mesomark test, blood is drawn from the patient and sent to a laboratory to measure the amount of SMRP, a particular biomarker. Certain elevated levels of SMRP indicate the presence of mesothelioma. The test’s makers suggest that early detection of the biomarker in a patient’s blood can lead to an early diagnosis, resulting in more treatment options and a better prognosis for the patient.

In addition to detecting the presence of mesothelioma in patients who have not yet been diagnosed with the disease, the Mesomark blood test may also be helpful for monitoring the success of treatments in patients who have already been diagnosed with mesothelioma. The blood tests might be used to help determine the future course of treatment in such patients.

The results of a study released by researchers at New York University in February 2007 suggest that the test may be effective. Dr. Harvey Pass of the Department of Cardiothoracic Surgery at NYU’s School of Medicine stated in a press release: “Our findings not only show that SMRP is indeed a valid biomarker for mesothelioma, but also justify further research as a prospective screening test.” Dr. Pass indicated that the test might assist researchers on their “way towards improving survival rates and the quality of life for patients diagnosed with this aggressive and often fatal disease.”

Mesomark was first released in Australia in March 2005 and in Europe a few months later. The Food and Drug Administration approved the blood test for humanitarian use only in the U.S. in January 2007. The test was developed by Fujirebio Diagnostics Inc. of Malvern, Pennsylvania.

Some biopsy procedures are performed to confirm the diagnosis of mesothelioma as well as to discover the extent to which a mesothelioma tumor may have spread in the patient’s body. This information is important for staging the cancer—that is, determining how advanced the cancer is. This information assists the physician and the patient in choosing appropriate treatment options. These biopsies include:

(i)                  Mediastinoscopy

(ii)                Bronchoscopy

Mediastinoscopy

A mediastinoscopy is done to learn whether an existing tumor has spread to the mediastinal nodes (the lymph nodes in the center of the chest). A mediastinoscopy involves inserting a lighted tube (mediastinoscope) under the chest bone at the level of the neck and moving the scope down into the chest. This allows the surgeon to view the lymph nodes in this area and to take samples to check for malignant mesothelioma. The mediastinoscopy is performed under general anesthesia with the patient completely asleep.

The lymph nodes are described as bean-sized collections of cells that help the body fight infections and cancers through the immune system. Lymph nodes exist everywhere in the body and act to filter out infection and tumor cells. Cancers in the lung commonly spread to the lymph nodes, but for mesothelioma, this is less common. Tests on sample lymph nodes taken during a mediastinoscopy, then, may help distinguish lung cancer from mesothelioma. In addition, the tests may reveal whether a cancer is still localized or has begun to spread. This determination is important because disease treatment will vary according to the status of the lymph nodes.

Bronchoscopy

If it is suspected that a patient has pleural mesothelioma, the doctor may also perform a bronchoscopy. In this procedure, a flexible lighted tube is inserted through the patient’s mouth, down the trachea, and into the bronchi to determine whether any other masses are present in the airway. Small samples of tissue that appears abnormal may be removed for analysis by a pathologist.

Diagnosing malignant mesothelioma often requires a biopsy, in addition to the physical examination and radio graphic test. To have a biopsy, a physician or a medical oncologist, a physician who specializes in diagnosing and treating cancer, removes a sample of tissue to be studied under a microscope by a pathologist. A biopsy is performed in different ways, depending on the location of the tissue to be removed.

If the suspected mesothelioma is in the chest, either in the lungs or heart, a thoracoscopy is done. A thoracoscopy is performed by making a small cut in the chest and putting a lighted tube called a thoracoscope into the chest between the ribs. If the suspected mesothelioma is in the stomach, a peritoneoscopy is done. A peritoneoscopy is performed by cutting a small opening in the abdomen and using a peritoneoscope to get samples of the abnormal cells. The doctor may also wish for more extensive tests or diagnostic surgery.

In tissue biopsy, tissue samples can be obtained through a needle biopsy, in which cells are extracted through a long needle using a very small incision. Lately a more open surgical biopsy is considered as most reliable means of diagnosing mesothelioma.

After a biopsy is performed, the tissue obtained is sent to medical experts to determine the occurrence of mesothelioma. If fluid is removed during a thoracentesis or thorascopy, the fluid is sent to a Cytology lab for analysis. A tissue obtained in biopsy will be sent to a surgical pathology lab for analysis. The same procedure is followed in case when an entire tumor, pleura or lung is surgically removed. After analysis is completed, small pieces of any remaining tissue are preserved in paraffin wax for future use. Regardless of where the biopsy material is sent, the patient’s physician will receive a written report of the results. The doctor may receive an oral report from the lab prior to the written results.

Analysis of the biopsy material will be conducted by a pathologist. A pathologist is a doctor who specializes in identifying and determining the cause of diseases. He is trained to analyze abnormal cell growth, which can reveal the presence of mesothelioma, and other diseases.

The pathologist will remove a razor thin layer of tissue from the sample, set the tissue on a microscope slide, add dye to the slide to make the cells more visible, and then seal the slide so it can be viewed under a microscope. It is difficult to diagnose mesothelioma just by looking at the cells in the fluid taken from around the lungs, abdomen, heart, or from the tissue obtained in a small needle biopsy. Because under the microscope, mesothelioma may have the appearance of some other types of cancer. For instance, pleural mesothelioma may look like some types of lung cancer and peritoneal mesothelioma may seem to be a cancer of the ovaries. Due to this reason, special laboratory tests are often performed on the biopsy tissue to help distinguish mesothelioma from another type of cancer.

These tests often use special techniques to locate certain types of chemicals contained in mesothelioma tumors. These chemicals are called “markers”. Immunohistochemistry is a special technique which is used to observe certain proteins on the surface of the cells. This test is used to find difference between mesothelioma and lung cancer, which can appear to begin in the lining of the chest cavity.

DNA Microarray analysis, a newer test, analyzes gene patterns in the tumor. Mesothelioma has different gene patterns than other types of cancers.

The electron microscope can also be used to analyze biopsy samples and help diagnose mesothelioma. The electron microscope can magnify biopsy samples 100 times or more than the traditional light microscope that is generally used in cancer diagnosis. The more powerful microscope enables doctors to see the small parts of the cancer cells that make mesothelioma different from other types of cancer.

A biopsy is not only useful for the pathologist who diagnoses a patient’s mesothelioma; a biopsy also allows the patient’s oncologist to analyze the possible spread of cancer cells to other parts of the body. When a complete tumor is removed from the body, the pathologist carefully examines the edges, or “margins,” of tissue outside the tumor to see if cancer is present. An appearance of “negative margins” means the cancer has probably not spread; the finding of “positive margins” indicates that the surgeon did not completely remove the cancer. Mesothelioma spreads quickly, so oncologists commonly order additional tests, including biopsies and x-rays on the affected parts of the body such as the lymph nodes. The mediastinoscopy is one such test.

Thoracentesis

Some mesothelioma patients develop fluid in their lungs. This is called a pleural effusion. During diagnosis the doctor will take a sample of this fluid with a needle injected into the chest and test the fluid for cancer cells. This procedure is called thoracentesis. Thoracentesis might also be performed for draining fluid from the lungs to help relieve pain. Although the procedure is quick and safe, its sensitivity is unfortunately less than 50 percent, and a negative test is generally not sufficient to rule out mesothelioma.

Thoracoscopy

A thoracoscopy permits a surgeon to look inside the patient’s chest. In this technique the surgeon makes one or two small incisions between the ribs and inserts a tube with a tiny video camera into the chest cavity. The doctor uses special forceps to remove the tissue sample as the tumor is viewed on a monitor screen connected to the telescope, called the thoracoscope. The procedure is sometimes called a VATS (video-assisted thoracic surgery) pleural biopsy. The surgeon take special care to make the incisions in a place on the chest where they can be incised given that cancer cells can contaminate any incision.

Laparoscopy or Peritoneoscopy

The technique laparoscopy is similar to a thoracoscopy. Laparoscopy in that it allows the surgeon to view and obtain a biopsy of a peritoneal tumor. The laparoscopy is also referred as peritoneoscopy. In a laparoscopy, the surgeon makes small cuts to the front of the abdomen and inserts a flexible tube with a tiny video camera into the abdominal cavity. The biopsy specimen is sent to the pathology laboratory for examination and interpretation by the pathologist. If the procedure fails to yield enough tissue for the pathologist’s study, however, more extensive diagnostic surgery may be employed.

Needle Biopsy

A patient suspected of having mesothelioma will often be given a needle biopsy at the start. For this procedure, the doctor uses a long, thin needle to take samples of cells from the chest, or from the abdomen or pericardial region for examination under a microscope. This test can be uncomfortable but may take only a few minutes. Small pieces of the tissue are taken and then sent to a laboratory for analysis.

The doctor might also use an x-ray, CT scan or fluoroscopy to guide the needle as it is inserted into the tumor. Fluoroscopy is a diagnostic procedure in which x-rays are passed through the body and then projected onto a screen, providing a continuous image of the body’s internal structures.

Tissue Biopsy

Alternate biopsy procedures involve a small incision through which a surgeon can operate a tiny telescope and other fine instruments to obtain a tissue sample. Fluid can also be collected during such procedures. These procedures, called thoracoscopy and laparoscopy/peritoneoscopy, are done in the hospital under general anesthesia.

Surgical Biopsy

Recently, mesothelioma doctors have determined that the open lung biopsy is the most reliable in making an accurate diagnosis. The procedure is a form of surgery and is done in the hospital under general anesthesia. The types of surgical biopsy are called thoracotomy and laparotomy.

Thoracotomy

A thoracotomy is a type of surgery to open the chest between the ribs to allow a surgeon to check for signs of disease. Sometimes, the surgeon will remove just a sample of tissue for testing. Other times, a larger portion of tumor is removed or, possibly, the entire tumor. The tissue will be forwarded to a pathologist for review and the patient’s physician will receive the report at a later time. A chest tube may be left in place for a few days after surgery to prevent the lung from collapsing.

Laparotomy

In laparotomy surgery the surgeon opens the abdomen of patient and inspects for signs of peritoneal mesothelioma and collects a sample of tissue for testing. Like thoracotomy technique, the tissue sample is sent to a pathologist for analysis. And the patient’s doctor is given the report at a later date.