DIAGNOSIS & TREATMENT

This website was developed as an on-line resource to provide up-to-date information on the causes, symptoms, and treatment of mesothelioma. The site also contains links to other valuable material regarding treatment and support for the victims and families of this devastating illness. We hope that you find this material helpful and that you will visit often to find the latest information regarding the fight against mesothelioma.

Asbestos and Mesothelioma

Asbestos is a naturally occurring group of minerals composed of fibers that can be separated into threads and woven. These fibers are strong, flexible and resistant to heat and chemicals. When bonded to other materials, asbestos fibers give products strength and stability. These characteristics have made asbestos popular in industry since the late 1800s, and an estimated 5,000 asbestos-containing products exist today.

There are two families of asbestos which differ based on the structure of their mineral crystals. Viewed under a microscope, the Amphibole family of asbestos has chainlike crystals, while the Serpentine family has layered sheets of fiber. The commercial industry uses four types of asbestos:

• Chrysotile, or white asbestos, accounts for almost 99% of asbestos used in the U.S. Chrysotile is in the serpentine family and has been linked to all asbestos-related illness;
• Crocidolite fibers are blue and are in the amphibole family;
• Amosite is in the amphibole family and has brown fibers;
• Anthophyllite, also an amphibole type asbestos has gray fibers

While asbestos fibers are extremely durable, when the fiber masses are disturbed they break apart and form a dust. The dust contains tiny fiber particles that become airborne and remain there for some time. Once asbestos settles, it can easily be disturbed and redistributed through a process known as reentrainment.

Airborne asbestos fibers can also be inhaled or swallowed. Once they enter the body, the fibers become lodged in tissues where they may remain latent (inactive) for up to 50 years. In the 1920s, asbestos fibers were linked to cancer and lung-related illness. By 1975 most of its uses were banned by the federal government and by 1989, the Environmental Protection Agency (EPA) had banned all new uses of asbestos. However, uses established prior to 1989 are still allowed. Today, asbestos use is tightly regulated and has dropped from the 719,000 cubic tons used in 1973 to 15,000 metric tons consumed in 1979. Still, there are an almost 733,000 buildings that were erected prior to the asbestos ban. Today, as many as 8 million people in the U.S. have already been exposed to asbestos and it continues to pose a serious threat to workers in certain occupations.

The building and construction industries use asbestos for strengthening cement and plastics. It is also used for insulation, fireproofing and sound proofing. Shipbuilders have used asbestos to insulate boilers, steam pipes and hot water pipes. Asbestos is used by the automotive industry in clutch pads and brake shoes. Other asbestos containing products include:

• Asbestos paper containing products such as heat and electrical wire insulation, industrial filters, table pads and sheet underlying flooring,
• Asbestos textile products like roofing materials, heat and fire-resistant fabrics including blankets and curtains,
• Ceiling and floor tile, paints, caulking and patching tape, coatings and adhesives, packing components, plastics.

While low-levels of exposure to asbestos are unlikely to cause significant health problems, workers who are exposed to asbestos through continuous contact with the fibers in their jobs face a very high risk of developing illness. Known as occupational exposure, the asbestos hazards are especially high in textiles, asbestos mining and milling, construction and building, demolition workers, drywall removers, auto workers (brake repair), ship builders, and power plants, oil and gas refineries, railroads, steel mills, people who reside near former asbestos manufacturing plants, Navy veterans, Merchant Marines, and Longshoremen. Families of workers are also susceptible to asbestos exposure through fibers that cling to industrial and trade worker’s clothes, shoes, skin and hair. This “second hand” exposure is known as paraoccupational exposure.

Once inhaled or swallowed, asbestos fibers travel to the lung where they become lodged in the pleura (the thin, saran-wrap type membrane lining the lungs). Scarring develops in the lungs and results in asbestosis, lung cancer and mesothelioma. Mesothelioma is a malignant tumor that aggressively invades the linings of the lungs, abdomen, heart or testicles. The two types of disease are pleural mesothelioma and peritoneal mesothelioma. Pleural mesothelioma spreads within the chest cavity and the metastases can occur in any organ, including the lungs and brain. Peritoneal mesothelioma penetrates the abdominal cavity and affects the liver, spleen or the bowel.

Every year, 2,500 to 4,000 patients are diagnosed with mesothelioma. One study of asbestos insulation workers reported a mesothelioma death rate up to 344 times higher than the general population.

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Symptoms, Diagnosis and Treatment

Symptoms
A mesothelioma diagnosis may be delayed because symptoms are generally non-specific and some patients do not even experience symptoms. The early symptoms of pleural mesothelioma may resemble viral pneumonia with a persistent cough and pain in the chest area. As the disease progresses, the accumulation of fluid (pleural effusion) in the chest cavity causes pain and is accompanied by difficult breathing and shortness of breath. Other pleural mesothelioma symptoms may include fever, loss, abdominal pain and swelling, bowel obstruction, night sweats, weight loss, blood clotting problems and anemia. Pain, difficulty swallowing and swelling of the neck or face may indicate that the cancer has metastasized beyond the mesothelium. Peritoneal mesothelioma symptoms may include the above, as well as swelling or abdominal pain due to a fluid build-up.

As the disease progresses, the cancerous cells harden the lung area and spread. As time passes, breathing, sleeping and eating become more difficult, and it becomes increasingly more challenging for the mesothelioma patient to engage in normal activities and enjoy life.

Diagnosis
Doctors use a variety of diagnostic procedures to determine if a patient has mesothelioma. These exams may include:

• imaging tests,
• visualization tests,
• pathological tests,
• biopsies, and
• pulmonary function tests.

Because of the difficulties in diagnosing mesothelioma, doctors may perform other tests to confirm the presence of the disease. If the pathologist confirms a diagnosis of Mesothelioma, the doctor may request tests such as a Positron Emission Tomography (PET) scan to evaluate the stage or extent of the disease to decide an appropriate course of treatment.

To establish risk factors and the presence of symptoms, your physician will complete a medical history that includes questions to help determine the timeframe and environment in which you may have been exposed to asbestos. A physical exam will be performed that focuses on confirming the signs of mesothelioma and other health problems. Doctors will look for pleural mesotheliomas (tumors of the chest) since these patients often have fluid in their chest cavity caused by the cancer. Victims of peritoneal mesothelioma may have fluid in their abdominal cavity and pericardial effusion (fluid in the pericardium, or sac around the heart) which can also be discovered upon a thorough physical exam.

Imaging Techniques

Imaging techniques include computed tomography (CT) scans, in which a rotating x-ray beam is used to take a series of pictures of the body from different angles. A computer combines the series of pictures to produce a detailed cross-sectional image of a specific part of the body. To further enhance CT scan details, patients may be asked to have a harmless dye injected into their vein. Magnetic resonance imaging (MRI) scans are another imaging process which uses magnetic fields rather than x-rays to create images of specific areas of the body. CTs and MRIs help to pinpoint the location, size, and extent of the cancer.

Pathological Tests
A complement to radiological testing is removing fluid and tissue samples from the patient for further study. Many of these tests are performed in the hospital under local anesthetic.

A tissue sample of a pleural or pericardial tumor can be obtained using a relatively new technique called thoracoscopy. A thoracoscope (telescope-like instrument connected to a video camera) is inserted through a small incision into the chest. The doctor can see the tumor through the thoracoscope and can use special forceps to take a tissue biopsy. A laparoscopy can be used to see and obtain a biopsy of a peritoneal tumor. In this procedure, a flexible tube is attached to a video camera that is inserted into the abdominal cavity via small incisions. Fluid can also be collected during thoracoscopy or laparoscopy.

When the surgeon wishes to remove a larger tumor sample (or to remove it entirely), surgery will be recommended. In a thoracotomy, tissue is removed from the chest cavity. A laparotomy involves tissue taken from the abdominal cavity.

Oral Exploration
A bronchoscopy may be performed if pleural mesothelioma is suspected. In this process, the doctor inserts a flexible lighted tube down the trachea, and into the bronchi to check for masses in the airway. At that time, small samples of abnormal-appearing tissue may also be removed for testing.

Lymph Node Analysis
Lymph nodes are collections of immune system cells that help the body fight infection. By examining the lymph nodes, the doctor can determine if the cancer has spread. During a mediastinoscopy, a patient has a lighted tube inserted under the sternum (chest bone) at the neck level and then moved down into the chest. The surgeon can see the lymph nodes and take tissue samples to check for cancer. This procedure can also help the physician determine if you have lung cancer or mesothelioma.

Pulmonary Function
Pulmonary function tests (PFT’s) encompass a wide variety of tests that evaluate the entire respiratory system. The tests are useful in the assessment and diagnosis of pulmonary disease and aid in determining a course of treatment. PFTs can be a simple peak flow measurement, or complex body plethysmography and ventilation/perfusion scans which are performed in hospitals and clinics.

Staging

Mesotheliomas are usually of three different cell types: 1) epithelial cell type - has the most favorable prognosis; 2) fibrosarcomatous cell type - carries the most negative prognosis and 3) mixed cell type - has an intermediate prognosis.

Using imaging studies such as MRI scans, x-rays and CT scans, physicians classify the spread (or “stage”) of cancer. Staging is important because it determines a patient’s course of treatment and for a better understanding of the prognosis. Pleural mesothelioma is the only mesothelioma for which a staging classification exists is because it occurs most frequently and has been studied the most.

The Butchart system is the most often used staging system for mesothelioma. This staging system is based primarily on the extent of the primary tumor mass and divides mesotheliomas into Stages I through IV. The following provides information on each stage and the most often associated treatment:

Localized Malignant Mesothelioma

• Stage I: cancer is present in the right or left pleura and may also exist in the lung, diaphragm, or pericardium.

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Treatment

If the cancer is only in one place in the chest or abdomen, treatment will most likely be surgery to remove part of the pleura and some of the tissue around it. If the cancer is found in a larger part of the pleura, one of the following may be performed: 

• Surgery to remove the pleura and the tissue near it to relieve symptoms, with or without radiation therapy after surgery.
• Surgery to remove sections of the pleura, the lung, part of the diaphragm, and part of the lining around the heart.
• External beam radiation therapy to relieve symptoms.
• A clinical trial of surgery followed by chemotherapy given inside the chest.
• A clinical trial of surgery, radiation therapy, and/or chemotherapy.

Advanced Malignant Mesothelioma

• Stage II: the mesothelioma has spread beyond the lining of the chest wall or involves the esophagus, heart or pleura on both sides. Mesothelioma may also exist in the chest’s lymph nodes.
• Stage III: cancer has spread into the chest wall, penetrated the diaphragm, and is present in the center of the chest heart and abdominal lining and into lymph nodes beyond the chest.
• Stage IV: there is evidence that mesothelioma has spread through the bloodstream to distant tissues and organs (distant metastases)

Treatment

1. Draining of fluid in the chest or abdomen (thoracentesis or paracentesis) to reduce discomfort. Drugs also may be put into the chest or abdomen to prevent further collection of fluid.
2. Surgery to relieve symptoms.
3. Radiation therapy to relieve symptoms.
4. Chemotherapy.
5. A clinical trial of surgery, radiation therapy, and chemotherapy
6. Chemotherapy given in the chest or abdomen.
   
   

Traditional Treatments

While there is currently no known cure for malignant mesothelioma, treatments are available with the most common being surgery, chemotherapy and radiation therapy. Doctors will often use two or more of these treatment courses jointly to provide the maximum likelihood of success. This “multimodal” approach holds the most promise for survival of malignant mesothelioma patients. Trimodality therapy, in which all three of these modalities are used, is considered the most effective aggressive approach.

Your doctor will recommend one treatment or a combination of therapies that are best for your situation. The course of treatment will depend on a number of factors including the location of the disease, the stage of the disease, your age, overall health and your preferences.

Surgery

There are several types of surgeries used to treat mesothelioma and the disease type and stage will determine the type of surgery. Mesothelioma tumors are usually large and difficult to completely remove, so surgery is usually combined with other cancer treatments to ensure the best results in destroying the tumor. 

There are two main types of surgical treatment for pleural mesothelioma: extra-pleural pneumonectomy (EPP) and pleurectomy/decortication. EPP is the removal of the pleura, diaphragm, pericardium, and the whole lung involved with the tumor. Pleurectomy/decortication removes the pleura without removing the entire lung. Since EPP and pleurectomy/decortication are not frequently performed by most surgeons, patients are referred to centers specializing in these treatments. Many of these centers also specialize in other forms of mesothelioma treatment, either alone or in combination (multi-modal therapy.) Your doctor can discuss referrals.

Radiation therapy

Radiation therapy uses high-energy x-rays help to destroy cancer cells and shrink tumors. The radiation may come from outside the body from a machine (external radiation) or from radioactive materials placed directly in or around cancer cells through thin plastic tubes (internal or implant radiation). While there may be side effects from radiation, most of these will go away after a short while.

In pleural mesothelioma, it is difficult to irradiate tumor tissue successfully without injuring nearby organs like the lungs, heart, and liver. However, radiation therapy can be very effective in relieving pain in certain situations.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. Chemotherapy is referred to as systemic treatment because the drug is introduced into the patient’s bloodstream and travels throughout the body killing cancer cells. The drugs may be in pill form, or injected into the body through a needle. Researchers are also studying the effectiveness of delivering chemotherapy directly into the chest or abdomen (intrapleural or intraperitoneal delivery).

Chemotherapy may be given as the primary treatment to mesothelioma, or it may be used in addition to surgery. To effectively treat mesothelioma, more than one drug may be used. Depending on the drugs, the amount taken and the treatment period, there may be side effects. Historically, doxorubicin has been the most widely used single chemotherapy drug. Other newer drugs, including gemcitabine, cisplatin, carboplatin, epirubicin, cyclophosphamide, ifosfamide, vinorelbine, paclitaxel, and methotrexate, now are often preferred and are usually given in different combinations.

Recently, the University of Chicago Cancer Research Center released the results of a yearlong clinical trial of Pemetrexed Disodium (Alimta). A clinical study has shown positive results when Alimta was used with vitamins and the traditional chemotherapy drug, Cisplatin, for treating malignant pleural mesothelioma. Because of its ability to reduce tumors, prolong survival and reduce pain, Alimta is available to some pleural mesothelioma patients on a “compassionate use” basis. Patients who have not yet received treatment for mesothelioma may be eligible to obtain Alimta free of charge prior to the Food and Drug Administration’s completion of its formal review of the drug in 2004.

There are several new experimental treatments that try to enhance the immune system's ability to combat malignant mesothelioma. These include gene therapy and the use of cytokine proteins such as interferons and interleukins. These treatments are also being tested in combination with chemotherapy and other treatments.

Non-Traditional Treatments

Photodynamic Therapy

Photodynamic therapy destroys cancer cells by using the energy from light and may also be effective when combined with surgery. Although this treatment is in the experimental stage for mesothelioma, it has shown promising results in treating other cancers. In the procedure, the patient receives a photosensitizer (a drug which makes cells sensitive to specific wavelengths of light) which collects in cancerous cells but not in healthy cells. Once the cells have been sensitized, fiber optic cables are placed in the body (usually through open-chest surgery) so that the correct frequency of light can be focused on the tumor. This causes the photosensitizer drug to produce a toxic oxygen molecule which kills the cancer cell.

Gene Therapy

This is a new treatment, currently in clinical trails. This approach allows treatment to target tumors, rather than destroying healthy cells which is the negative of traditional chemotherapy. In gene therapy, cancer is treated by altering genetic defects that allow a tumor to develop. A “suicide gene” is inserted directly into the tumor, making the cells sensitive to a normally ineffectual drug. The drug is then administered to the newly sensitive cancer cells and it destroys those cells while leaving the healthy cells unharmed.

Gene therapy for mesothelioma is being researched at the University of Pennsylvania.

Immunotherapy

Immunotherapy (or biological therapy) treats cancer by using the body’s own immune system fight cancer cells. Another name often applies to this therapy, biological response modifiers (BRMs). Though not yet obtainable, promising clinical studies are underway for immunotherapy.

In addition to traditional forms of treatment, some cancer patients are turning to the alternative medicine’s healing philosophies and spiritual approach to living with the disease.

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Mesothelioma Specialists

Manjit S. Bains, M.D., F.A.C.S., Thoracic Surgery at the Memorial Sloan-Kettering Cancer Center in New York City.
http://www.mskcc.org/prg/prg/bios/48.cfm

Robert Cameron, M.D., Director of Thoracic Oncology at the University of California at Los Angeles (UCLA) School of Medicine.
http://www.surgery.medsch.ucla.edu/divisions/ct/
cv/cameron.htm

Philippe A. Chahinian, M.D., Mount Sinai Hospital, New York City.
http://www.mountsinai.org/common/detail.jsp?
nav=dd&hosp=msh&Doctor_ID=774&alpha=1

Mark Cullen, M.D., Directory of the Yale Occupational and Environmental Medicine Program at Yale University School of Medicine, New Haven, Connecticut.
http://www.med.yale.edu/intmed/occmed/pages/cullen.html

Jack A. Elias, M.D., Chief of Pulmonary and Critical Care Medicine Section, Yale University School of Medicine, New Haven, Connecticut.
http://www.med.yale.edu/intmed/pulmonary/faculty/elias.html

Bruce G. Haffty, M.D., Therapeutic Radiology, Yale Cancer Center, New Haven, Connecticut.
http://info.med.yale.edu/ycc

Graeme L. Hammond, M.D., Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
http://info.med.yale.edu/yfp/referral/surg/car.html

David H. Harpole, Jr., M.D., Associate Professor of Surgery, Thoracic Oncology Program/Assistant, Professor of Pathology, Duke University Medical Center, Durham, NC
Phone: (919) 684-3683

David Jablons, M.D., Chief of General Thoracic Surgery at the University of California in San Francisco (UCSF) Medical Center.
http://www.ucsf.edu/thoracic/bio.html

Theirry Jahan, M.D., 2356 Sutter Street, 7th floor, San Francisco, CA 94115 (415) 567-5581. 
Larry Kaiser, M.D., Chief of the Thoracic Oncology Research Laboratory at the University of Pennsylvania Medical Center in Philadelphia.
http://www.uphs.upenn.edu/surgery/fac/lrk.html

Mary Louise L. Keohan, M.D., Assistant Professor of Clinical Medicine, Columbia University College of Physicians and Surgeons/New York Presbyterian Hospital, New York, NY
Phone: (212) 305-4076

Mark Lischner, M.D., 2 Medical Plaza, Suite 100, Roseville, CA 95661 (916) 786-7498.
http://www.myhealth.com/mark_lischner/default.htm

Harvey I. Pass, M.D., Chief of Thoracic Oncology at the Barbara Ann Karmanos Cancer Institute in Detroit, Michigan. (This Institute is associated with Wayne State University.)
http://www.karmanos.org/we/second/thoracic/

Roman Perez-Soler, M.D., Associate Director of Clinical Oncology/New York University Kaplan Cancer Center, New York, NY
Phone: (212) 263-8043

Carrie A. Redlich, MD, MPH, Associate Professor of Occupational and Environmental Medicine, Yale University School of Medicine, New Haven, Connecticut.
http://info.med.yale.edu/intmed/cardio/occmed/redlich/
redlichcv.html#Address

Lary Robinson, M.D., Director of the Division of Cardiovascular and Thoracic Surgery and the principal Thoracic Surgical Oncologist at the H. Lee Moffitt Cancer Center & Research Institute in Tampa, Florida.
http://www.moffitt.usf.edu/physician/popups/detailpop.asp?
staffcode=1912

Valerie Rusch, M.D., F.A.C.S., Alfred P. Sloan Chair at the Memorial Sloan-Kettering Cancer Center in New York City.
http://www.mskcc.org/prg/prg/bios/51.cfm

Dong M. Shin, M.D., Associate Professor of Medicine, Department of Medical Oncology/M. D. Anderson Cancer Center, Houston, TX
Phone: (713) 792-6363

Daniel Sterman, M.D., Assistant Professor, Department of Medicine/University of Pennsylvania Medical Center, Philadelphia, PA
Phone: (215) 614-0984

David J. Sugarbaker, M.D., Chief of the Division of Thoracic Surgery at Brigham & Womens Hospital in Boston, Massachusetts.
http://www.chestsurg.org/sugbak.htm, 
http://www.moffitt.usf.edu/providers/ccj/v4n4/article4.html

Paul Sugarbaker, M.D., Director, Surgical Oncology/Washington Cancer Institute, Washington, D.C. Phone: (202)877-3908

Robert N. Taub, M.D., Professor of Clinical Medicine, Columbia University College of Physicians and Surgeons/New York Presbyterian Hospital, New York, NY
Phone: (212) 305-4076

Eric Vallieres, M.D., Associate Professor of Surgery, Section of General Thoracic Surgery/University of Washington Medical Center, Seattle, WA
Phone: (206) 598-4477

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Mesothelioma Clinical Trials and Information

These resources are provided to help you locate clinical trials for new mesothelioma treatments:

Acurian: Clinical trials which are actively enrolling participants; http://www.acurian.com/patient

National Institute of Health listing of clinical trials related to cancer: http://www.cancer.gov

http://www.Cancertrialshelp.org; National Cancer Cooperative Group’s available trials.

http://www.centerwatch.com: listings of more than 41,000 active industry/government sponsored trials.

http://www.clinicaltrials.coh.org/asp/default.asp

http://www.clinicaltrials.gov – NIH’s global resource for clinical trials

http://www.cancercare.harvard.edu/cli/find.asp – Dana-Farber Cancer Institute’s Massachusetts based center lists wide variety of clinical trials.

http://cancer.duke.edu/ctrials – Duke Comprehensive Cancer Center lists trials offered through Duke researchers.

www.lillytrials.com/cancer/cancer_trials.shtml – Eli Lilly Clinical Trials – Pharmaceutical company with trials for mesothelioma and lung cancer patients.

http://www.fhcrc.org/patient/ - Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance

http://www.moffitt.usf.edu/ - H. Lee Moffitt Cancer Center & Research Institute of South Florida

http://www.hci.utah.edu/ - Huntsman Cancer Institute – University of Utah

http://www.mskcc.org/mskcc/html/44.cfm – Memorial Sloane-Kettering Cancer Center – New York, NY

http://www.oncolink.com/treatment/matching.cfm – Oncolink Clinical Trials Matching Service affiliated with the Abrahamson Cancer Center – University Pennsylvania

http://www.lungcanceronline.org – various pharmaceutical company clinical trials and other information.

http://roswellpark.org – Roswell Park Cancer Institute, the National Cancer Institute’s designated comprehensive cancer center

http://cancercenter.stanford.edu/clinicaltrials – University of Stanford clinical trials

http://hopkinskimmelcancercenter.org/clinicaltrials – John Hopkins’ cancer research.

http://ccc.uab.edu/clinicaltrials – University of Alabama at Birmingham Comprehensive Cancer Center

http://cc.ucsf.edu/trials/adult_index_thoracic.html – University of California Comprehensive Cancer Center trials for thoracic cancer.

http://www.cancer.med.umich.edu – University of Michigan Comprehensive Cancer Center

http://www.mdanderson.org/patients_public/clinical_trials/ - Houston’s Anderson Cancer Center clinical trials.

http://unmc.edu/cancercenter/trials.htm – UNMC Eppley Cancer Center at University of Nebraska

http://www.veritasmedicine.com – on-line health resource with comprehensive clinical trials database.

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Mesothelioma Treatment Centers

Alabama
University of Alabama at Birmingham Comprehensive Cancer Center, Mesothelioma Treatment Section 
Francisco Robert, MD 
205-934-5077 http://www.ccc.uab.edu/

ALASKA
Ketchikan General Hospital, Ketchikan, AK

ARIZONA
Columbia Medical Center, Phoenix, AZ
Good Samaritan Regional Medical Center, Phoenix, AZ
Mayo Clinic, Scottsdale, AZ
Arizona Cancer Center, Mesothelioma Treatment Section 
Linda Garland, MD 
520-626-3434 http://www.azcc.arizona.edu/

CALIFORNIA
City of Hope Comprehensive Cancer Center, Mesothelioma Treatment Section 
626-359-8111 http://www.cityofhope.org/

Cedars-Sinai Medical Center Mesothelioma Treatment Section 
310-423-5874 http://www.csmc.edu/

Thoracic Oncology, Department of Surgery, UCLA Medical Center Mesothelioma Treatment Section 
310-794-7333 1 http://www.surgery.medsch.ucla.edu/

Tower Hematology Oncology Medical Group Mesothelioma Treatment Section 
310-289-2840 http://www.toweroncology.com/

Mt. Zion Medical Center/ USCG, Mesothelioma Treatment Section 
415-885-3882 http://urology.ucsf.edu/clinicsHosp/hospZion.html

David Geffen School of Medicine University of Los Angeles Division of Pulmonary Mesothelioma Treatment Section 
310-206-7858 http://www.ucla.edu/search/contact/medicine.html

National Lung Cancer Research Program Cedars-Sinai Comprehensive Cancer Center 
310-423-8030 Toll free 1-800-CEDARS-1 2
http://www.cedars-sinai.edu/comprehensivecancercenter/

UCLA Medical School, Los Angeles, CA

COLORADO
University of Colorado Cancer Center, Mesothelioma Treatment Section 
303-315-8801 http://www.uccc.info/cancercenter/
content/home/default.asp?index=CancerHome&title=
UniversityColoradoCancerCenter

University of Colorado Cancer Center Department of Medical Oncology, Mesothelioma Treatment Section 
720-848-0300
http://www.uccc.info/cancercenter/content/home/
default.asp?index=CancerHome&title=UniversityoColorado
CancerCenter

University of Colorado Medical Center, Denver, CO

National Jewish Hospital, Denver, CO

CONNECTICUT
Yale Comprehensive Cancer Center, Department of Therapeutic Radiology, Yale University School of Medicine, Mesothelioma Treatment Section 
203-785-2959 http://www.yalecancercenter.org/index2.htm

KANSAS
CCOP-Wichita, Mesothelioma Treatment Section 
316-262-4467 http://www.cancercenterofkansas.com/home.htm

KENTUCKY
Kentuckian Cancer Institute, Mesothelioma Treatment Section
502-561-8200

LOUISIANA
CCOP-Ochsner, Mesothelioma Treatment Section 
504-842-3910 http://www.ochsner.org/

MARYLAND
NCI Surgery Branch/Baltimore VA Center, Baltimore, MD

Greenbaum Cancer Center, Mesothelioma Treatment Section 
410-328-2703 http://www.umm.edu/cancer/

Division of Thoracic Surgery and Surgical Oncology, University of Maryland Medical Center, Mesothelioma Treatment Section 
800-492-5538 http://www.umm.edu/center/

National Cancer Center, Mesothelioma Treatment Section 
301-496-2195 http://www.ncc.go.jp/

University of Maryland School of Medicine, Director of Thoracic Radiology, Mesothelioma Treatment Section 
410-328-8667 http://medschool.umaryland.edu/

Johns Hopkins University School of Medicine-Assistant Professor of Medicine & Oncology 
Mesothelioma Treatment Section 
410-502-10339 http://www.hopkinsmedicine.org/medicalschool/

National Cancer Institute, Mesothelioma Treatment Section 
301-402-3721 http://www.nci.nih.gov/

MASSACHUSETTS
Dana Farber Cancer Center Institute, Mesothelioma Treatment Section
617-632-3470 http://www.dfci.harvard.edu/

MICHIGAN
Mesothelioma Treatment Section 
616-391-1230

Barbara Ann Karmanos Cancer Institute, Mesothelioma Treatment Section 
313-745-8746 http://www.karmanos.org/

St. Joseph Mercy Hospital –Oakland, Mesothelioma Treatment Section
248-858-6215 http://www.mercyoakland.com/

McAuley Cancer Care Bldg. Room C139, Mesothelioma Treatment Section 
734-712-1000s 11

University of Michigan, Mesothelioma Treatment Section 
734-936-4300 http://www.med.umich.edu

Karmanos Cancer Institute, Professor of Surgery and Oncology 
313-745-8746 http://www.karmanos.org/

MINNESOTA
University of Minnesota Cancer Center, Mesothelioma Treatment Section 
612-624-5631 http://www.cancer.umn.edu/

Veterans Affairs Medical Center-Minneapolis, Mesothelioma Treatment Section 
612-725-2000 12

Mayo Clinic, Mesothelioma Treatment Section
507-284-2511 http://www.mayo.edu/

MISSISSIPPI
University Of Mississippi Medical Center, Attn: Cancer Research Registry, Mesothelioma Treatment Section 
601-984-1095 http://www.umc.edu/

MISSOURI
VA Medical Center-Togus, Mesothelioma Treatment Section 
207-623-8411 http://www.visn1.med.va.gov/togus/

The Center for Cancer Care and Research Director, Clinical Research 
314-628-1210 http://tcccr.com/

Veterans Affairs Medical Center-Columbia (Truman Memorial), Mesothelioma Treatment Section 
573-814-6000

Barnes-Jewish Hospital, Mesothelioma Treatment Section 
314-747-3000 http://www.barnesjewish.org/

St. Louis University, Mesothelioma Treatment Section 
314-577-8854 http://www.slu.edu/

NEBRASKA
Good Samaritan Health Systems, Mesothelioma Treatment Section 
308-865-7564 http://www.gshs.org/

Creighton University Medical Center, Cancer Center-Suite 2321, Mesothelioma Treatment Section 
402-280-5009 http://medicine.creighton.edu/

NEVADA
CCOP-Southern Nevada Cancer Research Foundation Mesothelioma Treatment Section
702-384-0013

NEW HAMPSHIRE
Norris Cotton Cancer Center, Mesothelioma Treatment Section
603-650-5534 http://www.cancer.dartmouth.edu/index.shtml

NEW JERSEY
Somerset Medical Center, Mesothelioma Treatment Section 
908-685-2200 http://www.somersetmedicalcenter.com/

Norris Cotton Cancer Center-Dartmouth Hitchcock Medical Center, Mesothelioma Treatment Section 
603-650-6300 http://www.cancer.dartmouth.edu/index.shtml

NEW MEXICO
Director of Experimental Therapeutics, Cancer Research and Treatment Center, University of New Mexico
505-272-5837 http://hsc.unm.edu/crtc/

Mayo Clinic Cancer Center, Mesothelioma Treatment Section 
507-284-2511 http://www.mayo.edu/research/cancercenter/

NEW YORK
Roswell Park Cancer Institute, Mesothelioma Treatment Section 
716-845-5873

Memorial Sloan-Kettering Cancer, Mesothelioma Treatment Section 
212-639-6483

Department of Surgery, Columbia Presbyterian Medical Center Mesothelioma Treatment Section 
212-305-9468

Columbia-Presbyterian Medical Center, Herbert Irving Comprehensive Cancer Center 
Mesothelioma Treatment Section 
212-305-1252

New York Presbyterian Hospital, Mesothelioma Treatment Section 
212-746-2844 18

CCOP-Syracuse Hematology-Oncology Associates of Central New York, Mesothelioma Treatment Section 
315-472-7504

Regional Cancer Center Mesothelioma Treatment Section 
315-464-8200

NORTH CAROLINA
Comprehensive Cancer Center at Wake Forest University Mesothelioma Treatment Section 
336-716-2088 http://www1.wfubmc.edu/cancer/

Department of General Surgery, Wake Forest University School of Medicine, Mesothelioma Treatment Section 
336-716-4276 13 http://www.wfubmc.edu/school/

Lineberger Comprehensive Cancer Center, Mesothelioma Treatment Section
919-966-4431 http://cancer.med.unc.edu

NORTH DAKOTA
Medcenter One Health System, Mesothelioma Treatment Section
701-250-7355 http://www.medcenterone.com/

Altru Health Systems Mesothelioma Treatment Section 
701-780-6390 http://www.altru.org/

OHIO
CCOP-Toledo Community Hospital Oncology Program Mesothelioma Treatment Section
419-479-5605 http://www.tchop.com/

St. Joseph Health Center, Warren, OH

OKLAHOMA
CCOP-Sooner State, Mesothelioma Treatment Section 
918-499-2000

Southwestern Regional Medical Center, Mesothelioma Treatment Section 
918-496-5933

OREGON
Good Samaritan Hospital, Corvalis, OR
Oregon Health Sciences Center, Portland, OR

PENNSYLVANIA
CCOP-Geisinger Medical Center, Dept. Hematology/ Oncology, Mesothelioma Treatment Section
570-271-6045 http://www.geisinger.org/

Department of Radiation Oncology, University of Pennsylvania Hospital, Mesothelioma Treatment Section 
215-662-7296 http://www.med.upenn.edu/

Univ. of Pennsylvania Medical Center, Department of Cardiothoracic Surgery Mesothelioma Treatment Section 
215-662-7538 http://www.pennhealth.com/upmc/

Department of Radiation Oncology, University of Pennsylvania Hospital, Mesothelioma Treatment Section 
215-662-7296 http://www.med.upenn.edu/

Western Pennsylvania Hospital, Mesothelioma Treatment Section 
412-578-4355
http://www.asri.edu/wph/

UPMC Presbyterian-Co-Director of the Lung Cancer Center Mesothelioma Treatment Section 
412-647-4700 http://www.upmc.com/

Fox Chase Cancer Center, Mesothelioma Treatment Section 
888-369-2427 http://www.fccc.edu/

SOUTH CAROLINA
Medical University of South Carolina, Mesothelioma Treatment Section
843-792-4271 http://www.musc.edu/

TENNESSEE
Veterans Affairs Medical Center-Memphis, Mesothelioma Treatment Section 
1030 Jefferson Ave., Memphis, Tennessee 38104 
Baptist Memorial Hospital Memphis, TN

TEXAS
Lone Star Oncology, Mesothelioma Treatment Section 
512-343-2103 http://www.lonestaroncology.com/

University of Texas-MD Anderson Cancer Center Mesothelioma Treatment Section 
713-792-6363 http://www.mdanderson.org/

University of Texas-MD Anderson Cancer Center Mesothelioma Treatment Section 
713-792-6161 http://www.mdanderson.org/

S. R. Burzynski Clinic, Mesothelioma Treatment Section 
713-335-5697 http://www.cancermed.com/

Department of Thoracic and Cardiovascular Surgery, Section of Thoracic Molecular Oncology, The University of Texas M. D. Anderson Cancer Center, , 77030-4095 
713-792-6933 http://www.mdanderson.org/

Scott & White Clinic, Mesothelioma Treatment Section 
254-724-570 http://www.sw.org/

Hamon Center for Therapeutic Oncology, Mesothelioma Treatment Section 
214-648-4921 http://swnt240.swmed.edu/postdoc/HamonCenter.htm

Mesothelioma Treatment Section 
210-616-5945 http://www.ctrc.saci.org/index.asp

UTAH
Utah Valley State Hospital, Provo, UT

VERMONT
UHC Campus -St. Joseph 3, Mesothelioma Treatment Section
802-847-3827 http://www.vermontcancer.org/

Veterans Affairs Medical Center-White River Junction Mesothelioma Treatment Section 
802-295-9363

VIRGINIA
Center for Cancer Care, Mesothelioma Treatment Section
434-982-8410

Virginia Oncology Associates, Mesothelioma Treatment Section 
757-827-9400 http://www.virginiacancer.com/

MBCCOP-Massey Cancer Center, Mesothelioma Treatment Section
804-828-0450 http://www.vcu.edu/mcc/

WISCONSIN
Medical Oncology, University of Wisconsin Hospital and Clinics, Mesothelioma Treatment Section
608-263-8090 http://www.uwhospital.org/

WASHINGTON
Department of Surgery, University of Washington School of Medicine, Mesothelioma Treatment Section
206-543-3093 http://www.washington.edu/medicine/index.html
Diagnostic Specialties Laboratories, Bremerton, WA

Kennewick General Hospital, Kennewick, WA

University of Washington Medical Center, Seattle, WA

Swedish Tumor Institute, Seattle, WA

St. Joseph Hospital, Tacoma, WA

WEST VIRGINIA
Wheeling Hospital, Wheeling, WV

Mesothelioma Support Groups

These support groups provide counseling, education and communication for victims of life-threatening diseases.

http://www.acor.org/support.html - Association of Cancer Online Resources (ACOR) manages a mailing list for mesothelioma patients.

http://www.alcase.org/support/suptrgroups.html - Alliance for Lung Cancer, Advocacy, Support and Education Support Groups (ALCASE) national lung cancer support groups.

http://www.aicr.org/resource.html - American Institute for Cancer Research (AICR) Cancer Resource provides treatment information to cancer patients and their families.

http://www.cancercare.org/people/counseling - Cancer Care Counseling provides free professional counseling for individuals or professionally facilitated support groups.

http://www.amc.org/flash/cicl/f_cicl_aboutcicl.html - Cancer Information and Counseling Line (CICL) is a service of AMC Cancer Center to help people with cancer and their families.

http://www.hospiceworld.org/ - Hospicelink not-for-profit organization that offers information about hospice and palliative care. They can refer patients and their families to local programs.

http://www.wellness-community.org/ - National program of education, support and hope for cancer patients and their families.

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