Balkinization  

Sunday, August 05, 2007

Helpful FISA Posts

Marty Lederman

I'll try to keep a rough list here of links to posts and comments that provide helpful clarification or analysis of the new bill and its ramifications, or that really move the ball forward. I'll try to update at the bottom as more things come to my attention. (For basic background, here's the bill, S.1927; my preliminary analysis of the bill; my query about the background Fourth Amendment question; and some early remarks by Orin Kerr on that constitutional issue. Also, in our comments section, Jack and I have a little back-and-forth about the possible constructions of section 105B of the bill.)

Start, of course, with Jack's absolutely essential post putting this in a broader perspective.

Then check out this post by Publius at Obsidian Wings (it's a great site even when hilzoy is on vacation): "The White House bill includes some minimal hoops the government must first jump through, but to call them toothless is an insult to those without teeth. As those with children know, bare-gum chomps can still hurt the finger."

Publius's focus is on the lack of transparency -- the fact that we haven't had a public debate about whether the government should be able to freely listen in on all our foreign communications. Perhaps that's something that doesn't bother Americans much in this age -- who knows?:
It’s pretty clear that the administration wants the authority to conduct electronic surveillance basically anywhere and anytime for anti-terrorism purposes. Perhaps I’m naïve, but I think they’re motivated by good intentions. R egardless though, if you want this type of power, come out and say it. Let’s have a debate on that specific question.

Maybe privacy is quaint in the age of digitally-enabled terror. Maybe we need to rely on the political process (i.e., elections) for protection. I disagree with both views, but we should at least have that debate. Say what you will about John Yoo, he at least doesn’t pull punches. He wants a vast expansion of executive power and doesn’t try to dress it up in different clothes.

But "different clothes" is exactly what we got with the FISA debate. We got the White House spokesman pretending to affirm strong privacy and civil rights protections. We got a bunch of meaningless oversight procedures that do nothing but give the appearance of oversight. That’s not how democracy is supposed to work. More to the point, democracy can’t work when the terms of important debates are cloaked in dishonesty and Kabuki.
To similar effect, in our comments section (yes, it can be useful if we all simply ignore the provocateurs!), "occasional observer" observes this:

In the House debate just one Congressman alluded to the bill's failure to require the DNI to keep a running record of how many US persons were spied on and report to Congress. Even he failed to link this gap to the need for legislative oversight and re-evaluation down the road (without a repeat of what just went on). The useless Gang of Eight, the endless stonewalling, the reliance on newspapers to tell us what our government is doing -- none of these were spoken to.

I was stunned. The oversight function and the means and scope of intelligence gathering are easy to separate, hard to demagogue. A line in the sand could have been drawn, in negotiations and then on the floor. At worst they'd have come away with a strong talking point, an ability to say they fought the good fight, and a caret in the law for future reference.

I can only conclude that when push came to shove the Democrats didn't feel all that entitled to know what goes on. That's for the party that keeps us safe, the one that's tough enough to make life-and-death calls. The "24" guys.
Orin Kerr has now weighed in at some length. His general take is this: "On the merits, I think this legislation on the whole seems relatively well done. I would have tinkered with it in some ways, and there are parts I'm not sure about, but the basic structure seems pretty good. Given that this is a 6-month temporary fix, not a permanent change, I tend to support it. . . . I think I basically agree with the idea that if someone is outside the United States, FISA should not regulate the monitoring of their communications. [I assume Orin here means that it's ok regardless of the extent to which, or frequency with which, such surveillance also intercepts communications of U.S. persons.] Intelligence agencies have long been able to monitor such calls from listening posts outside the U.S. without triggering FISA (think Echelon); this legislation makes the same rule apply regardless of where the communication is routed." (To similar effect, see the very interesting comment in this thread by John Thacker. John and Orin both emphasize that certain international communications have long been beyond constitutional and statutory regulation, even where they involve interception of U.S. persons' communications. Now that the government has the ability to intercept a vastly greater percentage of such communications, should the deregulatory legal landscape change, or adjust?) Orin also notes that "I have a number of concerns about the legislation from a civil liberties perspective. For example, limiting judicial review to whether it is clearly erroneous that something is reasonably designed to target those reasonably believed to be outside the U.S. seems like a pretty weak threshold. I'm guessing that the FISA Court judges will be pretty tough on this despite the statutory language, but the statutory language itself is obviously very deferential." He also focuses on, and laments, the fact that the legislation requires ISPs and service providers to give the NSA access when requested.

In comments to Orin's post, Just an Observer gets right to the heart of what seems to me to be the critical question:
On the one hand, I have long been sympathetic to the general principle that it is a good idea to restore the rough balance that was struck in FISA in 1978, a balance that has been disturbed by technological shifts. And on one level, that is what this bill does. This legislation and the associated debate are making explicit what apparently true in 1978, but was deliberately obfuscated: That by
"directing" our surveillance at parties abroad, our government legally is allowed to listen in on most all their communications with citizens here at home, without warrants or serious regulation.

On the other hand, I am not at all sure most people even realized that is what was going on all along 25-30 years ago, and the dissonance is jarring. The same technological shifts that make it necessary to gather almost all communications at telecom switches, ISPs, etc., also make it possible. This makes a big qualitative change in the tradeoff between liberty and security. It is more feasible for the government to slurp in everything and process it, rather than just targeting certain lines. So while the 1978 legislation did not require a foreign party legally to be identified as a "target," technology effectively did require isolating them.

If the government decades ago wanted to target all my international calls, it used to be that it would be forced to do so explicitly and get a warrant. It lacked the capacity to surveille all international communications and then filter out mine. Today, that capacity is being approached.

Matt Yglesias: "[T]he Democratic presidential candidates all seem opposed to this, but I'd put the odds of any of them actually taking action to reduce their own powers once in office at approximately zero percent." But fear not -- Matt also predicts that, "at some point years from now," there'll be a rollback when "some story will break about a truly abusive use of these surveillance authorities." Kinda like what happened to bring us . . . FISA.

Comments:

Would anyone care to argue whether or not Section 105C requires the FISA Court to issue an advisory opinion in violation of Art. III requirements? The language requiring the court to "assess" the legality of government conduct brought to mind Muskrat v. US.
 

Thanks for all the posts and analysis.
.
Section 105C is interesting in principle, in that it sets up a completely secret court review process, all the way to SCOTUS.
.
As for the sunset, there is an iterplay btween "the order" (which doesn't sunset) and "the law" that authorizes the order. If the order has an indefinite expiration date, then sunsetting the law that authorizes the order is pretty much a meaninless action.
 

To similar effect, in our comments section (yes, it can be useful if we all simply ignore the provocateurs!), "occasional observer" observes this:

In the House debate just one Congressman alluded to the bill's failure to require the DNI to keep a running record of how many US persons were spied on and report to Congress.


Most likely, both parties dropped this provision as completely unworkable.

If you recall, the TSP involves passive computer monitoring of telecommunications to and from telephone numbers captured from al Qaeda which go through our telecommunications hubs. Active monitoring of the telecommunications is triggered when the passive computer surveillance picks up jihadist language including that discussing likely high value targets. (Hollywood actually did a fair duplication of how this technology works in the new film the Bourne Ultimatum.)

The vast majority of so called "spying" involves the passive computer surveillance where the humans at NSA are neither recording nor listening in on the telecommunication. The NSA would actually have to listen in on all these communications to determine if the computer was monitoring a US person. Not only is this physically impossible for lack of personnel, but the loss of privacy would be infinitely more intrusive than simply allowing the computer to passively go about its work.

Folks, if we can dial down the uninformed and unreasoning hysteria for awhile and apply the actual disclosed facts to the actual law, I believe you will find that many of your imagined fears are unfounded.
 

Bart,

Would you care to provide us with the sources that inform your imagining of the TSP that we are supposed to "recall" above, or are you just providing us with unfounded assurances?
 

To say that "the TSP is" something is to prove that one knows absolutely nothing, since those who know aren't telling.

There is no such thing as "active" surveillance, as that is an oxymoron. There is automated surveillance and surveillance by humans, but the result is precisely the same -- a loss of privacy.

Since the communication being "tapped" will be recorded in either case, and that recording will be available by anyone with a proper clearance, such as Karl Rove (just as an example of someone known to have a clearance to view data classified as secret), the distinctions made here are pointless.

Disclaimer: I've used sloppy, non-technical language to describe technical matters. Use with caution.
 

Mark, Bart gave his source: The Bourne Ultimatum. Not all knowledge can be obtained from 24.
 

Once again, please use the comments section to advance the discussion. Please do not respond to Bart and others like him, period. Thanks.
 

Publius's focus is on the lack of transparency -- the fact that we haven't had a public debate about whether the government should be able to freely listen in on all our foreign communications.

True enough, but under FISA the government already could "listen in" on our all foreign communications that did not pass through a US switch, if you mean electronic collection. However, the various "minimization procedures" mentioned in the FISA statute have to be followed. All of those are a result of previous acknowledgments that the identity of people whose signals were intercepted can sometimes not be identified until later. You are correct that the extent and scope allowed is a change, but some of the later commentators should realize that certain of their particular objections are against things that already existed and are not part of this bill. E.g.:

Since the communication being "tapped" will be recorded in either case, and that recording will be available by anyone with a proper clearance, such as Karl Rove (just as an example of someone known to have a clearance to view data classified as secret), the distinctions made here are pointless.

I suggest reading the FISA statute in any case. The distinctions are not pointless, unless you think that the FISA statute was already pointless. You should read up on the "minimization procedures" in that paragraph and the next. Those electronically recorded signals have to be deleted by 72 hours currently if there is no warrant or probable cause. Most US person signals are detected and deleted electronically without any operator involvement. Recording the number of such signals would also be injurious to privacy, perhaps moreso than just deleting them as is done now. (OTOH, it might be useful for the "substantial likelihood" test of section 1802 (a)(1)(B).)

People raise good points about privacy concerns, but many of those are already present in FISA without this amendment, including the collection of US person signals when abroad, and the electronic surveillance without court order authorized in section 1802 (a) that has existed since before the current President was in office. (Yes, the intelligence community reorg in 2004 did affect that paragraph, but only by substituting Director of National Intelligence for Director of Central Intelligence.)

So while all those are reasonable privacy concerns, some people should realize that many of those concerns already existed.

The bill does have significant effects, of course. The significant effect is that it considerably eases the requirements for intercepting foreign signals obtained from surveillance directed at foreign persons when it cannot be guaranteed that they will not be talking to a US person on the other end, and it appears to lift the restriction on installing US-based devices to collect wholly foreign signals. (Currently, the FISA statute defines "electronic surveillance" to include anything based in US territory; however, in the modern age signals whose endpoints are both not in the US do often pass through US territory.)

It's true that we certainly haven't had a tremendous debate over whether signals crossing the border should be searched. However, I do seem to think that many people find it acceptable to routinely search goods and physical objects crossing the border. Indeed, I believe that many Democrats have run on the platform of saying that more physical objects should be searched when crossing, even all of them. Of course, even under this law one doesn't capture all signals for the same reason that we don't search all containers; technically impossible and incredibly expensive with a poor cost-benefit.
 

However, I do seem to think that many people find it acceptable to routinely search goods and physical objects crossing the border. Indeed, I believe that many Democrats have run on the platform of saying that more physical objects should be searched when crossing, even all of them. Of course, even under this law one doesn't capture all signals for the same reason that we don't search all containers; technically impossible and incredibly expensive with a poor cost-benefit.

I've never quite understood this comparison. A physical object might be dangerous in and of itself (i.e., it might be a bomb). Whatever the value of telephone calls or emails might be from an intelligence standpoint, they are not dangerous in and of themselves.

In addition, inspection of physical objects doesn't generally infringe on First Amendment concerns, whereas surveillance of emails and phone calls does do so. That makes the potential for abuse much greater.

Given these two important distinctions, there would be nothing inconsistent in adopting different standards.
 

John Thacker,

I find that reading legal material unbearably boring, and so I appreciate those who read it and comment in terms I can stay awake reading.

The question that concerns me is not the operation of the NSA or FBI if all the laws or regulations are obeyed in spirit as well as in letter, but the opportunities for mischief that are implicit in the operation.

The new act seems to me to open new avenues for mischief by legalizing the placing of taps on any node through which information might pass involving some non-citizen and providing insufficient oversight of this operation.

Given the viral nature of electronic copying, I don't believe that the deletion requirement will ever be met consistently, and I see no way for citizens to believe that it will be.

Quite frankly, I see this as a large increment in institutionalizing the electronic surveillance of citizens.
 

Marty Lederman said...

Once again, please use the comments section to advance the discussion. Please do not respond to Bart and others like him, period. Thanks.

Professor Lederman:

If I am not mistaken, the subject of your post was the FISA reform statute. My comment was a direct response to a quote you posted. Thus, exactly what about my post do you contend does not "advance the discussion?"

If you disagree with my analysis, you can at least grant me the basic courtesy of a reasoned response rather than claiming that I am changing the subject.

Unless, of course, by advancing the discussion, you mean making only those points which advance the politically correct view of this subject. In that case, you are seeking a Greek chorus and not to advance any discussion at all. I would be severely disappointed if this were the case.
 

I'm thoroughly confused about the purpose of
"SEC. 105C. (a) No later than 120 days after the effective date of this Act, the Attorney General shall submit to the Court established under section 103(a), the procedures by which the Government determines that acquisitions conducted pursuant to section 105B do not constitute electronic surveillance."...

Is this simply to give the government 4 months to prepare arguments that certain existing programs are not surveillance?

e.g. a hypothetical program that does accurate multilingual speech to text on all domestic telephone conversations, but doesn't actually involve people reading the transcripts (and then possibly listening to recordings to verify the correctness of the transcript) unless a warrant is obtained.
 

Marty, do you agree that the section 105B(h) provision for legal challenges by carriers is essentially meaningless?

Specifically, I don't see how the carriers would have standing to assert jus tertii if they thought an overseas US person's Fourth Amendment rights were being violated. At most, they might be able to object that Target X is in fact inside the US and thus not properly the subject of a section 105B directive.
 

Marty asked: Publius's focus is on the lack of transparency -- the fact that we haven't had a public debate about whether the government should be able to freely listen in on all our foreign communications. Perhaps that's something that doesn't bother Americans much in this age -- who knows?:

That's an interesting question in this age of MySpace, Girls Gone Wild and reality TV. Given the zeitgest, IMO a national surveillance state would be acceptable to most Americans as long as they could recover against the govt in tort for violations of the 4th A.
 

Unless I'm confused, isn't the fundamental problem with this bill the fact that it allows the executive to conduct surveillance without regard to the purpose of that surveillance?

Speaking for myself only, I don't have a huge problem with NSA's wiretapping an American citizen -- provided that some neutral magistrate gets to OK that his electronic communications are being surveilled because there is probable cause to believe that the subject of surveillance is involved in terrorism.

If there is no neutral oversight that surveillance by the NSA is actually related to national security, that is a very big problem. And that, it seems to me, is what the real problem with this bill is.

Or am I missing something?
 

BG:

Did FDR submit his spying on U.S. citizens during WWII to Congress or any court?
 

Did FDR submit his spying on U.S. citizens during WWII to Congress or any court?

Did the Supreme Court's first decisions finding Fourth Amendment protection for phone calls -- Katz and Berger (1967) -- occur much later?
 

[JaO, quoted in the post]: On the other hand, I am not at all sure most people even realized that is what was going on all along 25-30 years ago, and the dissonance is jarring. The same technological shifts that make it necessary to gather almost all communications at telecom switches, ISPs, etc., also make it possible. This makes a big qualitative change in the tradeoff between liberty and security. It is more feasible for the government to slurp in everything and process it, rather than just targeting certain lines. So while the 1978 legislation did not require a foreign party legally to be identified as a "target," technology effectively did require isolating them.

If the government decades ago wanted to target all my international calls, it used to be that it would be forced to do so explicitly and get a warrant. It lacked the capacity to surveille all international communications and then filter out mine. Today, that capacity is being approached.


This is quite true. In fact, the CALEA Act was an acknowledgement that the technology had changed with the advent of mobile telephony and the Internet (reflected in CALEA updates), so that the archetypical "tap" [the guy with the alligator clips on the local telephone pole] -- which was by nature capable of picking up all the conversations of the subject, and only those conversations -- was no longer feasible.

With CALEA came the requirement for centralised facilities for interception (a technological constraint), but also the requirement for specificity in the target (a legal constraint). In practise, the "specificity" requirement was also a practical one, as the means of delivery of the data to the LEAs was limited by financial and structural constraints; you couldn't put in enough circuits from the telco equipment to the LEAs to handle "broad sweeps" or to let the LEAs do the "filtering", and you really didn't want to (nor did you want the LEAs to do -- or have access to -- the provisioning, so as to be able to snoop on their own accord).

Technology has swung back a bit from that; now OC48 links are practical and getting cheaper by the minute, and computing power is getting large enough to handle the volumes of traffic in more massive interceptions.

In addition, the loss of "locality" and of "identity" in more modern digital communications has made the "filtering" process more difficult, leading some to say, "grab it all, and we'll sort it out later".

Couple that with desires for metadata analysis, traffic analysis, and such, and the push is on for greater quantities of (and capacity for) intercepted data. What was both technically infeasable and legally dubious has now become only a question of policy (and/or law).

So we now should debate what the policy should be: Should we allow snoops? What kind of information? What level of information? For what purposes? And under what circumstances (including level of "suspicion")?

Cheers,
 

Thank you very much for this information.

sohbet mirc
sesli sohbet
sohbet
muhabbet
evden eve nakliyat
 

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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
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jaundice, or yellowing of the eyes and skin
low blood sugar level
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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
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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.
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There is no universally agreed protocol for screening people who have been exposed to
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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.
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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.
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Commercial
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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
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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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