Balkinization  

Monday, December 27, 2004

So What

Mark Graber

The recent prison abuse scandals have the same feel of the recruitment scandals that occasionally rock college sports. Once every year or so, a particularly egregious scandal hits the front page, at least of the sports section. University administrators profess shock. Investigations are promised, heads will roll. Sometimes a coach is fired. Then other stories take over the front page. The investigator’s report barely makes the local college newspaper. Two years later, the "disgraced" coach is hired at some equivalent institution of "higher" learning. The real scandal is that everyone knows that published abuses of the recruitment process are probably routine and in most places, and few people really want to do anything about it. What we want as faculty and administrators is plausible deniability, whatever that means.

Guantanamo Bay is no different. Most Americans probably suspect that our nation now routinely tortures persons and that the President has sanctioned this policy. We sort of know this is wrong, but as long as we can maintain plausible deniability, who really cares. Thus, while we profess outrage when stories hit the front page, the outrage vanishes as soon as the stories disappear. Besides, some victims of torture might give up valuable information. Others are no doubt bad people, who might well torture us in appropriate circumstances. Most are people we do not know, and in America, people we do not know are people Americans need not care about. This is the real scandal, and it is about us. Beneath all the media talk of a politics of morality, George Bush and his cohort are deeply amoral people, and American under George Bush is a deeply amoral place. The real challenge for the left is making people care about torture, even when torture is not on the front page.

Comments:

Can't the same be said of genocides? Who remembers the Armenians? Never again? But, it goes on and on. Samantha Power reminds us all the time, bless her, but then there are the tax cuts, social security, and the other important things in life that neocons are pushing. Who has time to be compassionate, other than our exalted compassionate conservative President, unless you're against him and are thus evil.
 

This issue was not really mentioned during the presidential campaign, suggesting again how easy the administration truly had it in certain ways: somehow, perhaps rightly, the competition did not think the public would truly want their leader to be seriously challenged, since maybe they too share his sentiments a bit too much.
 

As a conservative, I am anti-torture. I think that we, as Americans, hold ourselves to a higher standard than those in other countries, and we try to live up to principles of morality rather than expediency. While there are no doubt going to be situations like this in every war, they should be dealt with in a way to ensure that those responsible are punished, and that everyone else understands that this behavior is unacceptable.

A quote I found in The Janson Directive (same author as the Bourne trilogy) sums it up nicely:

Our society betrays humanity whenever it doesn't live up to expressed ideals. And the world your friends wish to create? It betrays humanity whenever it does live up to its expressed ideals.I get quite pissed off when I hear about people going after our military and administration for these types of scandals. We know it was wrong. We don't like it either. But when our opposition is abducting and beheading people, a few pictures of prisoners being humiliated tends to be a lot less sensational.

People who are outraged at Americans for this type of behavior should be outraged a hundred-fold at the bastards beheading hostages and broadcasting it on the internet. I'm a little outraged at the Abu Ghraib scandal, but it pales in comparison with the anger I have at the savagery exhibited by the terrorists in Iraq.
 

One of the signs of patriotism or at least attachment is to be angrier at the United States for its war crimes whatever their relative seriousness compared with others. Torture committed by representatives of the United States is done in our name for our interests. We are implicated in it. We are betrayed by it.
 

Steve,
Are you QUESTIONING MY patriotism?!?! (oops, sorry, had a John Kerry moment there... my bad!)

Any-who, are you actually saying that being more angry at some stupid private who took a few pictures of naked terrorists than at people who behead others is a badge of patriotism? I completely agree that we, as Americans, should hold ourselves to a higher standard. America, since its founding, has tried to be a beacon of light in the world, one of the first societies truly based on the rights of individuals and the rule of law.

But there is nothing unpatriotic about drawing a distinction between us and our enemy. We try, and occasionally falter, to live up to the rules of war as laid out by the Geneva Convention. Our enemy recognizes no rules of war. We try, and occasionally falter, to treat our prisoners with humanity. Those times we falter typically end up with an enemy who perhaps was humiliated, deprived of sleep, or at worst, bruised. Our enemy's modus operandi is to leave headless corpses.

Remember that for us torture is a failure to live up to our policies. For our enemies, torture is their policy. I refuse to accept that being more mad at some foolish kid who went to far at Abu Ghraib than our enemy is patriotic. You should be mad, certainly, but let's put our focus where it is needed: defeating the *true* sadists.
 

Brad,

Well said.

Terrorists in Iraq are living true to their principles - killing, maiming, war-mongering.

The question I pose is... are the American soldiers?

Chui
 

"Terrorists in Iraq are living true to their principles - killing, maiming, war-mongering.
The question I pose is... are the American soldiers?"

Chui,
Very interesting question. In reality, the answer to that question depends on your opinion of our government and our military. Either the soldiers committing these crimes (I will go far enough to call them crimes, not quite atrocities) are failing to live up to our military's principals, or our military's principals are wrong and they are simply acting it out.

I know quite a few soldiers. And from what I have seen, the vast majority are committed to the same moral principals as you or I. I believe if you talk to them, and you ask them about what their responsibilities are as an American soldier, they will explain that what the few bad apples have done does not accurately reflect on them. In fact, they get upset that people look down upon all soldiers from the example a few have set.

That being said, though, they understand the nature of their mission. Much monday-morning quarterbacking has been done over the soldier who killed the Iraqi that was wounded in a mosque. Given the situation, that soldier had to make a choice whether to risk himself and possibly others on the belief that the Iraqi was not booby-trapped or faking a wound, or take the Iraqi out and not take the chance. In a mosque, possibly still with enemy fighters, a non-secured "battlefield", I'll bet the majority of US soldiers make that same choice. In a situation where the enemy does booby-trap their dead, and fake wounds or death to inflict harm, the *nature of the mission* calls for that action. After a battlefield is secure, and when there is sufficient security to ensure an enemy is truly wounded and not acting with malice, such an action would be unacceptable.

I think the vast majority of our soldiers are living up to the principals that we both believe are correct, which is to respect the rights as evidenced in the Geneva Convention. However, the realities of war are going to force us into gray areas. In situations where violations of Geneva are obviously unwarranted and done maliciously (Abu Ghraib), the responsible parties should be punished for their crimes. In less clear situations (such as the shooting described above), I think we need to give the soldier in question the benefit of the doubt. When the decision for that soldier is being wrong or being dead, one would expect a soldier to err on the side of caution.

To answer your question, the principals of our military, and of our soldiers, are moral. Abuses such as Abu Ghraib are a result of our soldiers and military *FAILING* to live up to their moral principals, not enforcing bad principals.

Brad

PS - sorry to ramble
 

Most of these responses to Graber's post are, well, exasperating.

1. Surely all informed people, including critics of the Bush Administration, recognize there are differences between (a.) the specific methods of torture uncovered by the FBI and publicized by the photographic evidence from Abu Ghraib and (b.) outright beheadings and other murders.

2.) But how much weight should we place on this distinction? Obviously the United States of America should be held to a MUCH HIGHER standard than terrorists. Republicans and Democrats should have no problems agreeing on that point. But do they?

3.) The "do whatever it takes" crowd fails to recognize that America will make itself less safe in the long term because of these disclosures. Administration officials have been unable to identify any "high-value" sources of information from Guantanamo Bay. They have even admitted to journalists that Guantanamo Bay was filled with people who should not be there, but "if they weren't terrorists before, they surely are now, so we can't simply let them go." Incompetence plus torture = a new generation, a growing population of new terrorists with serious homicidal grudges against the U.S. For those people who want to toss our ideals aside when fear is triumphant, at least these kinds of consquentialist arguments should suffice to damn Bush's tenure.

4.) Another common excuse is that these disclosures should only damn the "few bad apples," and we cannot prevent these sorts of lapses. The problem with this excuse is that it is no longer consistent with the available evidence -- and the more that we are learning, the worse it looks for Bush. The "trend in the trickle" of evidence now being disclosed -- by FBI officials' memos, CIA officials, Administration memos, witness statements and photographic evidence -- is that what has occured at Guantanamo Bay, Iraq and Afghanistan is NOT simply the result of some "young scared soldier going too far" or "prank-like behavior." Our government has researched very carefully the possible forms of torture it would like to authorize and endorse. They did so secretly -- and even when questioned by Congress they refused to admit the extent of their planning. These policies go up the chain of command. It's that simple. Bush is the commander in chief - all of these actions took place under his watch. He is responsible, and from the evidence that's been reported SO FAR, it is apparent that he and/or his "team" knew about these policies and endorsed them.

Now, if these policies are evil AND ineffectual, why continue to support Bush?

5.) Here's the final kicker: We must not criticize Bush, because he will turn on the surrogates/GOP chain gang to attack the critic with "undermining our troops while they are in harm's way." It's at this point I truly become exasperated and blue: Who's responsible for putting the troops in such a truly horrific, unsafe, compromised, no-end-in-sight position? George W. Bush did - NOT his critics. It's George W. Bush who, after offering a public rebuke, runs and hides and lets young soldiers hang out there to dry when ditigal camera pictures are publicized. It's George W. Bush who, after offering a public rebuke, runs and hides and lets a frightened, exhausted soldier in Fallujah face the full brunt of a court martial for a murder caught on tape. But it was George W. Bush who put these soldiers there. George W. Bush created a climate of moral opacity. George W. Bush failed to put enough soldiers on the ground in Iraq. George W. Bush rushed to invade Iraq and failed to plan how his soldiers could secure borders and guard armament stockpiles.

When you consider all the consequences of his tenure, how would you describe it? For me, words like venal, cynical, incompetent, and dangerous really don't do enough to capture his failures. Americans can be sophisticated enough to avoid the fallacy of moral equivalence, and yet still damn the administration of George W. Bush.
 

"As a conservative, I am anti-torture."

As a conservative?As if it is a political question? Odd way to phrase your opposition.
 

David,
You're right... It was an odd way to phrase what I intended to say, and it came across wrong. I was trying to first identify myself as a conservative, and then start the rest of my post. It was not intended as one naturally follows or does not follow from the other, but that is the natural reading.

My bad.
 

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Blog agréable.

Je devrai revenir plus tard.
 

mesothelioma Mesotheliomais a form of cancer that is almost always caused by exposure to Asbestos In this disease, malignant cells develop in the mesothelium, a protective lining that covers most of the body's internal organs. Its most common site is the pleura (outer lining of the lungs and internal chest wall), but it may also occur in the peritoneum (the lining of the abdominal cavity), the heart the pericardium (a sac that surrounds the heart or tunica vaginalis.
Most people who develop
mesothelioma have worked on jobs where they inhaled asbestos particles, or they have been exposed to asbestos dust and fiber in other ways. Washing the clothes of a family member who worked with asbestos can also put a person at risk for developing Mesothelioma Unlike lung cancer, there is no association between mesothelioma and smoking but smoking greatly increases risk of other asbestos induced cancer.Compensation via
Asbestos funds or lawsuits is an important issue in
mesothelioma The symptoms of
mesothelioma include shortness of breath due to pleural effusion (fluid between the lung and the chest wall or chest wall pain, and general symptoms such as weight loss. The diagnosis may be suspected with chest X-ray and CT scan and is confirmed with a biopsy (tissue sample) and microscopic examination. A thoracoscopy inserting a tube with a camera into the chest) can be used to take biopsies. It allows the introduction of substances such as talc to obliterate the pleural space (called pleurodesis, which prevents more fluid from accumulating and pressing on the lung. Despite treatment with chemotherapy, radiation therapy or sometimes surgery, the disease carries a poor prognosis. Research about screening tests for the early detection of mesothelioma is ongoing.
Symptoms of mesothelioma may not appear until 20 to 50 years after exposure to asbestos. Shortness of breath, cough, and pain in the chest due to an accumulation of fluid in the pleural space are often symptoms of pleural
mesotheliomaSymptoms of peritoneal
mesothelioma include weight loss and cachexia, abdominal swelling and pain due to ascites (a buildup of fluid in the abdominal cavity). Other symptoms of peritoneal
mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.
These symptoms may be caused by
mesothelioma or by other, less serious conditions.
Mesothelioma that affects the pleura can cause these signs and symptoms:
chest wall pain
pleural effusion, or fluid surrounding the lung
shortness of breath
fatigue or anemia
wheezing, hoarseness, or cough
blood in the sputum (fluid) coughed up hemoptysis
In severe cases, the person may have many tumor masses. The individual may develop a pneumothorax, or collapse of the lung The disease may metastasize, or spread, to other parts of the body.
Tumors that affect the abdominal cavity often do not cause symptoms until they are at a late stage. Symptoms include:
abdominal pain
ascites, or an abnormal buildup of fluid in the abdomen
a mass in the abdomen
problems with bowel function
weight loss
In severe cases of the disease, the following signs and symptoms may be present:
blood clots in the veins, which may cause thrombophlebitis
disseminated intravascular coagulation a disorder causing severe bleeding in many body organs
jaundice, or yellowing of the eyes and skin
low blood sugar level
pleural effusion
pulmonary emboli, or blood clots in the arteries of the lungs
severe ascites
A
mesothelioma does not usually spread to the bone, brain, or adrenal glands. Pleural tumors are usually found only on one side of the lungs
Diagnosing
mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient's medical history. A history of exposure to asbestos may increase clinical suspicion for
mesothelioma A physical examination is performed, followed by chest X-ray and often lung function tests. The X-ray may reveal pleural thickening commonly seen after asbestos exposure and increases suspicion of
mesothelioma A CT (or CAT) scan or an MRI is usually performed. If a large amount of fluid is present, abnormal cells may be detected by cytology if this fluid is aspirated with a syringe. For pleural fluid this is done by a pleural tap or chest drain, in ascites with an paracentesis or ascitic drain and in a pericardial effusion with pericardiocentesis. While absence of malignant cells on cytology does not completely exclude
mesothelioma it makes it much more unlikely, especially if an alternative diagnosis can be made (e.g. tuberculosis, heart failure
If cytology is positive or a plaque is regarded as suspicious, a biopsy is needed to confirm a diagnosis of
mesothelioma A doctor removes a sample of tissue for examination under a microscope by a pathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples.
If the cancer is in the abdomen, the doctor may perform a laparoscopy. To obtain tissue for examination, the doctor makes a small incision in the abdomen and inserts a special instrument into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary.
There is no universally agreed protocol for screening people who have been exposed to
asbestosScreening tests might diagnose mesothelioma earlier than conventional methods thus improving the survival prospects for patients. The serum osteopontin level might be useful in screening asbestos-exposed people for
mesotheliomaThe level of soluble mesothelin-related protein is elevated in the serum of about 75% of patients at diagnosis and it has been suggested that it may be useful for screening. Doctors have begun testing the Mesomark assay which measures levels of soluble mesothelin-related proteins (SMRPs) released by diseased mesothelioma cells
Incidence
Although reported incidence rates have increased in the past 20 years, mesothelioma is still a relatively rare cancer. The incidence rate is approximately one per 1,000,000. The highest incidence is found in Britain, Australia and Belgium: 30 per 1,000,000 per year. For comparison, populations with high levels of smoking can have a lung cancer incidence of over 1,000 per 1,000,000. Incidence of malignant mesothelioma currently ranges from about 7 to 40 per 1,000,000 in industrialized Western nations, depending on the amount of asbestos exposure of the populations during the past several decades. It has been estimated that incidence may have peaked at 15 per 1,000,000 in the United States in 2004. Incidence is expected to continue increasing in other parts of the world. Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age. Approximately one fifth to one third of all mesotheliomas are peritoneal.
Between 1940 and 1979, approximately 27.5 million people were occupationally exposed to asbestos in the United States.[ Between 1973 and 1984, there has been a threefold increase in the diagnosis of pleural mesothelioma in Caucasian males. From 1980 to the late 1990s, the death rate from mesothelioma in the USA increased from 2,000 per year to 3,000, with men four times more likely to acquire it than women. These rates may not be accurate, since it is possible that many cases of mesothelioma are misdiagnosed as adenocarcinoma of the lung, which is difficult to differentiate from mesothelioma.
Working with asbestos is the major risk factor for mesothelioma. A history of asbestos exposure exists in almost all cases. However, mesothelioma has been reported in some individuals without any known exposure to asbestos. In rare cases, mesothelioma has also been associated with irradiation, intrapleural thorium dioxide (Thorotrast), and inhalation of other fibrous silicates, such as erionite.
asbestos
is the name of a group of minerals that occur naturally as masses of strong, flexible fibers that can be separated into thin threads and woven.
asbestos
has been widely used in many industrial products, including cement, brake linings, roof shingles, flooring products, textiles, and insulation. If tiny asbestos particles float in the air, especially during the manufacturing process, they may be inhaled or swallowed, and can cause serious health problems. In addition to mesothelioma, exposure to asbestos increases the risk of lung cancer, asbestosis (a noncancerous, chronic lung ailment), and other cancers, such as those of the larynx and kidney.
The combination of smoking and
asbestos exposure significantly increases a person's risk of developing cancer of the airways (lung cancer bronchial carcinoma). The Kent brand of cigarettes used
mesothelioma in its filters for the first few years of production in the 1950s and some cases of
mesothelioma have resulted. Smoking modern cigarettes does not appear to increase the risk of mesothelioma.
Some studies suggest that simian virus 40 may act as a cofactor in the development of mesothelioma.
Asbestos was known in antiquity, but it wasn't mined and widely used commercially until the late 1800s. Its use greatly increased during World War II Since the early 1940s, millions of American workers have been exposed to asbestos dust. Initially, the risks associated with
asbestos exposure were not publicly known. However, an increased risk of developing mesothelioma was later found among shipyard workers, people who work in asbestos mines and mills, producers of asbestos products, workers in the heating and construction industries, and other tradespeople. Today, the U.S. Occupational Safety and Health Administration (OSHA) sets limits for acceptable levels of
asbestos exposure in the workplace, and created guidelines for engineering controls and respirators, protective clothing, exposure monitoring, hygiene facilities and practices, warning signs, labeling, recordkeeping, and medical exams. By contrast, the British Government's Health and Safety Executive (HSE) states formally that any threshold for
mesothelioma must be at a very low level and it is widely agreed that if any such threshold does exist at all, then it cannot currently be quantified. For practical purposes, therefore, HSE does not assume that any such threshold exists. People who work with
asbestos wear personal protective equipment to lower their risk of exposure. Recent findings have shown that a mineral called erionite has been known to cause genetically pre-dispositioned individuals to have malignant mesothelioma rates much higher than those not pre-dispositioned genetically. A study in Cappadocia, Turkey has shown that 3 villiages in Turkey have death rates of 51% attributed to erionite related
mesotheliomaExposure to
asbestos fibres has been recognised as an occupational health hazard since the early 1900s. Several epidemiological studies have associated exposure to asbestos with the development of lesions such as asbestos bodies in the sputum, pleural plaques, diffuse pleural thickening, asbestosis, carcinoma of the lung and larynx, gastrointestinal tumours, and diffuse mesothelioma of the pleura and peritoneum.
The documented presence of
asbestos fibres in water supplies and food products has fostered concerns about the possible impact of long-term and, as yet, unknown exposure of the general population to these fibres. Although many authorities consider brief or transient exposure to
asbestos fibres as inconsequential and an unlikely risk factor, some epidemiologists claim that there is no risk threshold. Cases of mesothelioma have been found in people whose only exposure was breathing the air through ventilation systems. Other cases had very minimal (3 months or less) direct exposure.
Commercial
asbestos mining at Wittenoom, Western Australia, occurred between 1945 and 1966. A cohort study of miners employed at the mine reported that while no deaths occurred within the first 10 years after crocidolite exposure, 85 deaths attributable to mesothelioma had occurred by 1985. By 1994, 539 reported deaths due to mesothelioma had been reported in Western Australia.
Family members and others living with
asbestos workers have an increased risk of developing
mesothelioma and possibly other asbestos related diseases. This risk may be the result of exposure to
asbestos dust brought home on the clothing and hair of
asbestos workers. To reduce the chance of exposing family members to asbestosMany building materials used in both public and domestic premises prior to the banning of
asbestos may contain
asbestos Those performing renovation works or activities may expose themselves to asbestos dust. In the UK use of Chrysotile asbestos was banned at the end of 1999. Brown and blue
asbestos was banned in the UK around 1985. Buildings built or renovated prior to these dates may contain asbestos materials.
For patients with localized disease, and who can tolerate a radical surgery, radiation is often given post-operatively as a consolidative treatment. The entire hemi-thorax is treated with radiation therapy, often given simultaneously with chemotherapy. Delivering radiation and chemotherapy after a radical surgery has led to extended life expectancy in selected patient populations with some patients surviving more than 5 years. As part of a curative approach to
mesothelioma radiotherapy is also commonly applied to the sites of chest drain insertion, in order to prevent growth of the tumor along the track in the chest wall.
Although
mesothelioma is generally resistant to curative treatment with radiotherapy alone, palliative treatment regimens are sometimes used to relieve symptoms arising from tumor growth, such as obstruction of a major blood vessel.
Radiation Therapy when given alone with curative intent has never been shown to improve survival from
mesothelioma The necessary radiation dose to treat mesothelioma that has not been surgically removed would be very toxic.
Chemotherapy is the only treatment for
mesothelioma that has been proven to improve survival in randomised and controlled trials. The landmark study published in 2003 by Vogelzang and colleagues compared cisplatin chemotherapy alone with a combination of cisplatin and pemetrexed (brand name Alimta) chemotherapy) in patients who had not received chemotherapy for malignant pleural mesothelioma previously and were not candidates for more aggressive "curative" surgery. This trial was the first to report a survival advantage from chemotherapy in malignant pleural
mesothelioma showing a statistically significant improvement in median survival from 10 months in the patients treated with cisplatin alone to 13.3 months in the combination pemetrexed group in patients who received supplementation with folate and vitamin B12. Vitamin supplementation was given to most patients in the trial and pemetrexed related side effects were significantly less in patients receiving pemetrexed when they also received daily oral folate 500mcg and intramuscular vitamin B12 1000mcg every 9 weeks compared with patients receiving pemetrexed without vitamin supplementation. The objective response rate increased from 20% in the cisplatin group to 46% in the combination pemetrexed group. Some side effects such as nausea and vomiting, stomatitis, and diarrhoea were more common in the combination pemetrexed group but only affected a minority of patients and overall the combination of pemetrexed and cisplatin was well tolerated when patients received vitamin supplementation; both quality of life and lung function tests improved in the combination pemetrexed group. In February 2004, the United States Food and Drug Administration approved pemetrexed for treatment of malignant pleural mesothelioma. However, there are still unanswered questions about the optimal use of chemotherapy, including when to start treatment, and the optimal number of cycles to give.
Cisplatin in combination with raltitrexed has shown an improvement in survival similar to that reported for pemetrexed in combination with cisplatin, but raltitrexed is no longer commercially available for this indication. For patients unable to tolerate pemetrexed, cisplatin in combination with gemcitabine or vinorelbine is an alternative, although a survival benefit has not been shown for these drugs. For patients in whom cisplatin cannot be used, carboplatin can be substituted but non-randomised data have shown lower response rates and high rates of haematological toxicity for carboplatin-based combinations, albeit with similar survival figures to patients receiving cisplatin.
In January 2009, the United States FDA approved using conventional therapies such as surgery in combination with radiation and or chemotherapy on stage I or II Mesothelioma after research conducted by a nationwide study by Duke University concluded an almost 50 point increase in remission rates.
Treatment regimens involving immunotherapy have yielded variable results. For example, intrapleural inoculation of Bacillus Calmette-Guérin (BCG) in an attempt to boost the immune response, was found to be of no benefit to the patient (while it may benefit patients with bladder cancer.
mesothelioma cells proved susceptible to in vitro lysis by LAK cells following activation by interleukin-2 (IL-2), but patients undergoing this particular therapy experienced major side effects. Indeed, this trial was suspended in view of the unacceptably high levels of IL-2 toxicity and the severity of side effects such as fever and cachexia. Nonetheless, other trials involving interferon alpha have proved more encouraging with 20% of patients experiencing a greater than 50% reduction in tumor mass combined with minimal side effects.
A procedure known as heated intraoperative intraperitoneal chemotherapy was developed by at the Washington Cancer Institute. The surgeon removes as much of the tumor as possible followed by the direct administration of a chemotherapy agent, heated to between 40 and 48°C, in the abdomen. The fluid is perfused for 60 to 120 minutes and then drained.
This technique permits the administration of high concentrations of selected drugs into the abdominal and pelvic surfaces. Heating the chemotherapy treatment increases the penetration of the drugs into tissues. Also, heating itself damages the malignant cells more than the normal cells.

What is the mesothelium?
The mesothelium is a membrane that covers and protects most of the internal organs of the body. It is composed of two layers of cells: One layer immediately surrounds the organ; the other forms a sac around it. The mesothelium produces a lubricating fluid that is released between these layers, allowing moving organs (such as the beating heart and the expanding and contracting lungs to glide easily against adjacent structures.
The mesothelium has different names, depending on its location in the body. The peritoneum is the mesothelial tissue that covers most of the organs in the abdominal cavity. The pleura is the membrane that surrounds the lungs and lines the wall of the chest cavity. The pericardium covers and protects the heart. The
mesothelioma tissue surrounding the male internal reproductive organs is called the tunica vaginalis testis. The tunica serosa uteri covers the internal reproductive organs in women.
What is mesothelioma?
mesothelioma (cancer of the mesothelium) is a disease in which cells of the mesothelium become abnormal and divide without control or order. They can invade and damage nearby tissues and organs.
cancer cells can also metastasize (spread) from their original site to other parts of the body. Most cases of mesothelioma begin in the pleura or peritoneum.
How common is mesothelioma?
Although reported incidence rates have increased in the past 20 years, mesothelioma is still a relatively rare cancer. About 2,000 new cases of mesothelioma are diagnosed in the United States each year. Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age.
What are the risk factors for mesothelioma?
Working with asbestos is the major risk factor for mesothelioma. A history of asbestos exposure at work is reported in about 70 percent to 80 percent of all cases. However, mesothelioma has been reported in some individuals without any known exposure to
Asbestos is the name of a group of minerals that occur naturally as masses of strong, flexible fibers that can be separated into thin threads and woven. asbestos has been widely used in many industrial products, including cement, brake linings, roof shingles, flooring products, textiles, and insulation. If tiny asbestos particles float in the air, especially during the manufacturing process, they may be inhaled or swallowed, and can cause serious health problems. In addition to mesothelioma, exposure to asbestos increases the risk of lung cancer, asbestosis (a noncancerous, chronic lung ailment), and other cancers, such as those of the larynx and kidney.
Smoking does not appear to increase the risk of mesothelioma. However, the combination of smoking and asbestos exposure significantly increases a person's risk of developing cancer of the air passageways in the lung.
Who is at increased risk for developing mesothelioma?
asbestos has been mined and used commercially since the late 1800s. Its use greatly increased during World War II. Since the early 1940s, millions of American workers have been exposed to asbestos dust. Initially, the risks associated with asbestos exposure were not known. However, an increased risk of developing mesothelioma was later found among shipyard workers, people who work in asbestos. Today, the U.S. Occupational Safety and Health Administration (OSHA) sets limits for acceptable levels of asbestos exposure in the workplace. People who work with asbestos wear personal protective equipment to lower their risk of exposure.
The risk o f asbestosrelated disease increases with heavier exposure to asbestos and longer exposure time. However, some individuals with only brief exposures have developed mesothelioma On the other hand, not all workers who are heavily exposed develop asbestos-related diseases.
There is some evidence that family members and others living with asbestos workers have an increased risk of developing mesothelioma, and possibly other asbestos-related diseases. This risk may be the result of exposure to
asbestos dust brought home on the clothing and hair of
asbestos workers. To reduce the chance of exposing family members to
asbestos fibers, asbestos workers are usually required to shower and change their clothing before leaving the workplace.
What are the symptoms of mesothelioma?
Symptoms of mesothelioma may not appear until 30 to 50 years after exposure to
asbestos Shortness of breath and pain in the chest due to an accumulation of fluid in the pleura are often symptoms of pleural mesothelioma. Symptoms of peritoneal mesothelioma include weight loss and abdominal pain and swelling due to a buildup of fluid in the abdomen. Other symptoms of peritoneal mesothelioma may include bowel obstruction blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.
These symptoms may be caused by
mesothelioma or by other, less serious conditions. It is important to see a doctor about any of these symptoms. Only a doctor can make a diagnosis
How is
mesotheliomadiagnosed?
Diagnosing mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient's medical history, including any history of asbestos exposure. A complete physical examination may be performed, including x-rays of the chest or abdomen and lung function tests. A CT (or CAT) scan or an MRI may also be useful. A CT scan is a series of detailed pictures of areas inside the body created by a computer linked to an x-ray machine. In an MRI, a powerful magnet linked to a computer is used to make detailed pictures of areas inside the body. These pictures are viewed on a monitor and can also be printed.
A biopsy is needed to confirm a diagnosis of mesothelioma. In a biopsy, a surgeon or a medical oncologist (a doctor who specializes in diagnosing and treating cancer) removes a sample of tissue for examination under a microscope by a pathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the
cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples. If the
cancer is in the abdomen, the doctor may perform a peritoneoscopy. To obtain tissue for examination, the doctor makes a small opening in the abdomen and inserts a special instrument called a peritoneoscope into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary.
If the diagnosis is mesothelioma, the doctor will want to learn the stage (or extent) of the disease. Staging involves more tests in a careful attempt to find out whether the cancer has spread and, if so, to which parts of the body. Knowing the stage of the disease helps the doctor plan treatment.
Mesothelioma is described as localized if the cancer is found only on the membrane surface where it originated. It is classified as advanced if it has spread beyond the original membrane surface to other parts of the body, such as the lymph nodes, lungs, chest wall, or abdominal organs.
How is
mesotheliomatreated?
Treatment for mesothelioma depends on the location of the
cancerthe stage of the disease, and the patient's age and general health. Standard treatment options include surgery, radiation therapy, and chemotherapy. Sometimes, these treatments are combined.
Surgery is a common treatment for
mesotheliomaThe doctor may remove part of the lining of the chest or abdomen and some of the tissue around it. For cancer of the pleura (pleural
mesotheliomaa lung may be removed in an operation called a pneumonectomy. Sometimes part of the diaphragm, the muscle below the lungs that helps with breathing, is also removed.
Stereo Tactic Radiation Therapy also called radiotherapy, involves the use of high-energy rays to kill
cancercells and shrink tumors Radiation therapy affects the
cancercells only in the treated area. The radiation may come from a machine (external radiation) or from putting materials that produce radiation through thin plastic tubes into the area where the
cancercells are found (internal radiation therapy).
Chemotherapy is the use of anticancer drugs to kill cancer cells throughout the body. Most drugs used to treat
mesotheliomaare given by injection into a vein (intravenous, or IV). Doctors are also studying the effectiveness of putting chemotherapy directly into the chest or abdomen (intracavitary chemotherapy).
To relieve symptoms and control pain, the doctor may use a needle or a thin tube to drain fluid that has built up in the chest or abdomen. The procedure for removing fluid from the chest is called thoracentesis. Removal of fluid from the abdomen is called paracentesis. Drugs may be given through a tube in the chest to prevent more fluid from accumulating. Radiation Therapy and surgery may also be helpful in relieving symptoms.
 


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