Mesothelioma- Asbestos Cancer

Don’t know what mesothelioma is? Neither did I, until I was contacted by Heather Von St.James, a survivor of mesothelioma, looking for bloggers to write about this rare condition. Much of the information pertaining to mesothelioma in this blog was gathered from www.mesothelioma.com  along with some Pathophysiology textbooks (Robbins Basic Pathology).The website is an exceptional source of information on the subject. As I have never worked with a client with Mesothelioma I’m taking a functional and herbalist perspective on the potential integrative approaches for supporting individuals with mesothelioma using herbal medicine, nutrition, supplements, and other modalities.

Cancer of the Mesothelium.

Mesothelioma is a cancer of the mesothelium, a tissue forming protective sacs surrounding the lungs (pleural mesothelium), abdominal cavity (peritoneal), or heart (pericardial). It is caused, almost exclusively, by exposure to asbestos.

What is Asbestos?

Asbestos is naturally occurring mineral which has been used commercially, though no-longer produced in the US and Europe it is still produced in Russia and China and is still commonly present in insulation in old homes (many of the water pipes in my grandmothers basement were insulated with asbestos). Though usage in construction has decreased, homes built prior to 1999 may still contain asbestos and in the US it remains a widely used industrial product. If you want to know more about the history of asbestos the wikipedia entry is a good starting place (http://en.wikipedia.org/wiki/Asbestos).

Asbestos and Health.

Tiny particles of asbestos enter the lungs and become trapped and over time can penetrate deep into tissue. Normally the lungs have multiple mechanisms for getting ride of particles such as hairs in your sinuses which trap particles and and the “mucociliary elevator” which consists of cells with little arm-like appendages covered in a sticky substance (mucus) which capture and then remove particles (next time you have a cold notice how well your mucociliary escalator is working each time you sniffle or cough). However the particular qualities of asbestos make it difficult to clear from the lungs. These fibers are highly irritating, triggering inflammation and fibrosis, the formation of scar tissue in the lungs. Additionally, potentially toxic chemicals (such as carcinogens from cigarettes), may be absorbed by asbestos fibers increasing their pathogenic (disease causing) qualities. One might think of it as the body trying to deal with these irritating fibers by healing around them, but this process is ineffective and may result in a sort of chronic wound that won’t heal, with the associated inflammation, free-radical damage, and un-checked formation of scar tissue on the mesothelium(plaques or if malignant tumors).

Asbestos exposure may result in:

1 – Asbestosis (parenchymal interstitial fibrosis or formation of scar tissue in the lungs) as it lodges in the lungs, potentially for decades, and results in irritation and inflammation leading to an increase in the chance of developing lung-cancer in general.

2 – Formation of localized, or occasionally diffuse, fibrous plaques on the pleura.

3 – Pleural effusion:  the presence of fluid in the pleural space.

4 – Lung cancer.

5 -Laryngeal cancer.

6 – Malignant mesothelioma.

So lets take a little look at mesothelioma and what the possibilities might be for supporting individuals diagnosed with mesothelioma from an integrative and herbal medicine perspective.

Malignant Mesothelioma.

In the US, about 2500-3000 cases are diagnosed each year. In 2011 there were about 2500 diagnosed cases in the UK. Information on worldwide prevalence is scanty but one research group estimated 14,200 cases yearly For more on mesothelioma statistics  go to:

(http://www.cancerresearchuk.org/cancer-info/cancerstats/types/Mesothelioma).

Risk Factors

What are the primary risk factors? Asbestos exposure. Secondary factors:  Smoking along with asbestos exposure greatly increases the likelihood of developing lung cancer but is not so strongly linked to mesothelioma (though tar and inflammation in the lungs would tend to promote growth of cancerous cells).

An important question worth investigating is why a given individual exposed to asbestos develops mesothelioma and why it becomes malignant.  Generally, in cancer, many factors may be at play.  These include genetics, epigenetics (how our genes are expressed in response to our environment), exposure to other risk factors that are carcinogenic (since these interact with the asbestos-caused inflammation and irritation in the lungs), and lifestyle actors (stress, exercise, nutrition, etc). All of these things coming together may create the perfect conditions which allow for the development and growth of cancer.  These factors point towards potential preventative measures that may significantly reduce your risk of developing mesothelioma, even if exposed to asbestos, as well as other forms of cancer.

Environment and Socioeconomics

Individual health and environmental health are inseparable. One can-not be obtained without the other. Yes, I’m passionate about the promotion of individual and ecological health, and I voice this passion not just because of my love of nature.  The above premise is not only supported by irrefutable logic, but it also stands upon a vast mountain of data. The link is particularly clear in mesothelioma because asbestos is so directly and clearly implicated. This is, in a strange way, a blessing, at least when it comes to advocacy for people with mesothelioma. In the US individuals with asbestos-related health conditions may be eligible for financial renumeration and don’t have to “prove their case” in the face of medical, political and economic skeptics. The history of asbestos is a testament to a hard fought battle: there are medically documented cases of asbestos related illness and attempts at health and safety regulations, which date back to the early 20^thcentury. Unfortunately this is not so clearly accepted in other conditions that have been well correlated by research in labs, as well as in population studies about the effects of exposure to synthetic chemicals, such as those in plastics, pesticides, and herbicides. (There are well over 85,000 of these chemicals used commercially in the US and only a few percent have been tested for health and environmental safety). Often causality is harder to prove as the effects of these compounds are more subtle, especially in the case of endocrine disruptors (such as xeno-estrogens, which interfere with our hormonal system and may promote growth of breast cancer cells if we have a pre-existing genetic vulnerability, exposure to multiple pollutants, poor diet, and are immune-compromised.

Along similar lines the socio-economic context of mesothelioma is clear: individuals working in careers that put them in frequent exposure to asbestos (shipyard workers, miners, insulators) as well as their families are most affected.  (Asbestos was carried into their homes on their clothing, thereby exposing spouses and children.) Men were more frequently working at these professions, and likely people of a certain socio-economic class. So we can see that disease is not merely individual; it also has environmental, social and economic components that must be addressed.

How does Asbestos cause cancer?

This is still not well understood. Asbestos fibers seem to preferentially lodge near the mesothelium where they generate free radicals (reactive oxygen species), causing DNA damage and potentially cancer-causing mutations. Malignant mesothelioma is generally preceded by fibrosis and formation of plaques in the pleural mesothelium – i.e., scar tissue. Genetic studies have shown several mutations of tumor suppressor genes in mesothelioma (p16/CDKN2A on chromosome 9p21 and NF2 on chromosome 22q12) (Robbins).  As we see in most cancers, the precipitating event (exposure to asbestos) triggers a network of events (inflammation, abnormal wound-healing process, free radicals, mutation and immune compromise) that, under certain physiological, genetic, and immunological conditions, may result in cancer.

Types of Mesothelioma

About ¾ are cancers of the pleura, which protects the lungs, though it may also affect the peritoneal mesothelium (surrounding the abdominal cavity) or rarely the pericardial mesothelium (surrounding the cardiac cavity). Though there are three known cell types, 50-70% of cases are cancers of the epithelial cells.

Signs and Symptoms

These depend greatly on which mesothelium has been affected. Furthermore, many other conditions may result in similar symptom patterns resulting in frequent misdiagnosis.

Pleural:  Symptoms often resemble other respiratory conditions, including adenocarcinoma of the lungs.  Misdiagnosis is common. Symptoms may include chest pain, chronic cough, effusions (release of fluid into a cavity) of the chest and abdomen, and blood and fluids in the lung. Sixty percent of those with pleural mesothelioma experience lower back or side-chest pain, frequent shortness of breath, possible difficulty swallowing, persistent cough, coughing up of blood, fever, weight loss or fatigue, muscle weakness, loss of sensory capability, facial and arm swelling, and hoarseness.

Peritoneal: Individuals with peritoneal mesothelioma often experience abdominal pain, weight loss, nausea, vomiting, and fluid build-up in the abdomen due to effusion.

Diagnosis

Unfortunately, mesothelioma is generally not detected until it has reached a very advanced stage. Though signs and symptoms may appear in as little as 10 years after exposure to asbestos, the average period is 35-40 years. The symptoms are often misdiagnosed, as they resemble many other more common conditions, resulting in significant loss of time before a correct diagnosis is made.  Diagnosis is generally made by interview, determination of asbestos exposure, imaging (MRI, CT scan, etc) and biopsies.

Conventional Treatment.

The standard tools of conventional medicine are applied; chemotherapy, radiation, and surgery. By the time it is detected it is often well-established and possibly metastasized and options for curative treatment are very limited (though not without hope), so the focus is often on palliative care. Early detection does make a difference, which is why raising awareness of this condition is so important.

An integral approach to prevention and treatment.

In this section we’ll take a look at what an Integral approach to supporting individuals with mesothelioma or “asbestos cancer.” might look at.Note to the reader: The standard disclaimer applies: These are NOT recommendations. This is an exploration of the potential applications of herbal medicine, supplements, and nutrition in cancer with a focus on mesothelioma. Integrative approaches to cancer are very complex and need to be carefully individualized in collaboration between patients, herbal practitioners and conventional medical providers. If this approach resonates with you, please contact me and I can point you toward a reputable practitioner. 

The herbal medicine or integrative medicine perspective on cancer sees cancer as a systemic (i.e. whole body) condition, not just a localized (limited to one or even several organs) disease. Though there may be a precipitating factor (asbestos) there is also an environment or a terrain. (From a holistic perspective, this would include spirit, mind, emotions, and body, physiology, immune function, emotional, and psychological conditions.). The focus is on restoring the interior environment (the mental, emotional and physical environment) to one that is inherently inhospitable to cancer.  In other words, a terrain where cancer can not thrive. This approach can safely and effectively be integrated with conventional treatments intended to directly kill cancer cells. Not only does it often decrease the side-effects of conventional treatment, it also frequently improves their effectiveness, while improving quality and quantity of life.

Integral Cancer Support

My general integral approach to cancer applies – the goal is to support the individual’s overall health (maintaining strength, vitality, and immune function) and to optimize conventional treatments.  One also tries to minimize side-effects and to establish or restore an environment in the body that is not supportive to cancer’s growth.  This includes re-establishing and strengthening the bodies natural anti-cancer defenses using herbs, supplements, nutrition and mind-body interventions such as meditation and HeartMath.  These have been correlated with improved immune function, decreased inflammation and an improved quality of life, while also addressing the psychological and emotional facets and impacts of disease. An additional focus is placed on supporting the function of the lungs the mesothelium.

A detailed blog on the subject is forthcoming, but for now, if you want to read more on my general approach, go to:

Integral Cancer Support

Strategies for Mesothelioma

In addition to these general approaches (specifically tailored for a given individual, her unique cancer, and her current state of health) let’s explore some strategies for supporting those with mesothelioma. As mesothelioma was unknown prior to the usage of asbestos in the 20^thcentury, there is no specific historical or traditional knowledge to guide us in the herbal treatment of cancer of the mesothelium. However, some of the historical texts on herbal medicine can provide avenues for investigation, such as the sections on Chronic Pleurisy and Sero-Fibrinous Pleurisy by Rolla Thomas, M.D. written in 1907 (from http://www.henriettes-herb.com/eclectic/thomas/index.html). Many of the symptoms experienced by individuals with mesothelioma may be effectively and safely alleviated with herbs and supplements. Here we’ll be stepping outside of the conventional perspective and taking a “functional” perspective. This will be directed at supporting the natural functions of the lungs and the mesothelium (the tissue affected by the cancer) and encouraging its innate healing-capacity. So what does the mesothelium do? A little bit of information from physiology texts provide a very basic insight.

The Mesothelium

The mesothelium is a tissue surrounding various organs. It is comprised of layers of cells. One of its primary roles is the secretion of lubrication by the mesothelia cells. This allows for free motion of the organs they protect, such as the lungs, heart, and stomach. For example the free motion of the lungs as they expand with the in-breath and contract with the out-breath. Take a deep inhalation and notice how smoothly that movement occurs, the abdomen followed by the chest expanding with no sense of friction or discomfort, and then contracting just as smoothly during your exhalation. That’s a dozen or so breaths a minute, with seamless motion reliant upon the lubrication provided by the pleural mesothelium. So just think of your heart, moving with every single beat, within the pericardium! Clearly the mesothelium plays a very neglected “behind the scenes” role in the healthy functioning of our bodies and it deserves some serious appreciation.

Now, quoting Wiki for this well-summarized technical paragraph:

“The mesothelium is also implicated in the transport and movement of fluid and particulate matter across the serosal cavities, leukocyte migration in response to inflammatory mediators, synthesis of pro-inflammatory cytokines, growth factors, and extracellular matrixproteins to aid in serosal repair, and the release of factors to promote the disposition and clearance of fibrin(such as plasminogen). Mesothelial cells are capable of phagocytosisand are antigen presenting cells. Furthermore, the secretion of glycosaminoglycansand lubricants may protect the body against infection and tumor dissemination.”

In other words the pleural mesothelium plays an important role in removing particles (dust, pollen, asbestos) that have made their way into the lungs. Furthermore, it assists in our immune response by helping white blood cells get where they need to be: into damaged tissue, bacterial or viral infections, and cancerous cells.  The white blood cells start a proper inflammatory, immunological, and reparative response along with facilitating the clean-up of the aftermath. The mesothelial cells themselves have significant immune capacity. Glycosaminoglycans (GAGs), are long-chain polysaccharides (often called muco-polysaccharides). They have many functions, including lubrication.  In the lungs, they help with protection of tissue. They help keep our nasal passages moist and protect them from irritants, and they also protect our stomach from digesting itself with its own acid.  They aid in prevention and clearance of bacteria before, during and after infections. (That sticky green or yellow mucus you experience during a nasty cold is your body cleaning out unwanted debris). All of these functions, when healthy and balanced, can play a role in the prevention of cancer and the inhibition of its growth and metastasis.

Herbal Medicine and Mesothelioma

So, what does all of this have to do with herbal medicine?  Well, for thousands of years, herbs have been used that support the function of the lungs and the mucous membranes. Herbs were used for the treatment of colds, flus, bronchitis, pneumonia, tuberculosis, pleurisy and other respiratory conditions. The herbs can be regarded as falling into several categories:

Working with the Respiratory System

Part of the art and science of herbal medicine is selecting herbs that have a specific affinity for a given tissue type or organ. This is where many of the herbal texts shine, in particular those of the Eclectic doctors (such as the previously cited Rolla Thomas, MD), as well as in the Chinese and Ayurvedic medical traditions.  They had a great understanding of which plants demonstrated an affinity for a specific organ or tissue type. Furthermore, these herbs can sometimes help concentrate the effects of other remedies upon the targeted organ. For example, ever heard of “garlic breath”? The allyl-sulfides, the primary category of immune-stimulating, anti-microbial, expectorant, and anti-inflammatory compounds in garlic are secreted via….the lungs. If you want to prove this for yourself, cut a clove of garlic in two and tape it to the sole of your foot. Walk around on it all day and observe what happens to the scent of your breath. Garlic is also a circulatory stimulant.  By enhancing blood flow to the lungs as well as increasing the flow of GAGs, it may improve access to the lungs of phytochemicals, supplements, and pharmaceuticals — as well as the possibly improving the ability of the immune system to reach the tumor.

Many aromatic compounds are also excreted via the lungs, such as the essential oils in thyme and oregano.  This helps explain why these highly anti-microbial and expectorant herbs have such a wide tradition of usage for bronchial infections. They can be taken as strong teas. A very few essential oils can be taken internally (oregano oil capsules are widely available) but be cautious as many are potentially dangerous! Many essential oils with respiratory and anti-cancer properties may be applied to the chest or even inhaled for direct diffusion into the respiratory system. They’ll enhance respiration – relaxing the respiratory system, deepening breathing, improving circulation, and possibly exerting direct anti-inflammatory, immune, and anti-cancer affects. They also have profound emotional and psycho-spiritual affects which can play an important role in relieving anxiety, elevating mood, and transforming maladaptive emotional states that may play a contributing role in disease. Someone trained in the holistic usage of essential oils and aromatherapy can help direct you in choosing essential oils that have these subtle energetic and psychospiritual properties in addition to their medical applications.

Respiratory Tonics:

These are herbs that generally improve the function of the respiratory system, in particular the lungs. They might include: solomon’s seal, Schisandra, Mullein, Lobelia, Mint and some of the medicinal mushrooms (Reishi). Improved respiration will result in better oxygenation.  (Cancer thrives in a hypoxic, low oxygen, environment.) In low-oxygen environments cancer promotes angiogenesis, the formation of blood-vessels, to feed its growth. Targeting angiogenesis is one of the primary strategies of integrative (and increasingly conventional) cancer treatments.

Mucolytics and Expectorants:

These are herbs that help break up mucous, alter the consistency and quantity of mucous, and result in the expectoration of mucus and other fluids. They include mullein, colt’s foot, comfrey, licorice, bryonia, pleurisy root (used for the treatment of pleuritis).They could help improve the clearance of particulates, the dissemination of white blood cells, and would support healthy mesothelial function. They may also help with effusion, the build up of liquid in the lungs or pleural cavity.

Mucosal Membrane tonics

These improve the tone and function of mucous-producing membranes. The goal here is to support the health of the mesothelial tissue and to encourage the appropriate production of GAGs. A few examples include myrrh, goldenseal,  goldenrod, and pleurisy root (which has an affinity for the mucous membranes of the respiratory tract) .

Immunomodulators and Inflammatory modulators

These modulate immune function and inflammation. They are amphiteric which means they generally decrease excessive immune activity and inflammation, including aspects of immune dysregulation implicated in cancer.  They also increase deficient immune activity, thus improving the body’s ability to contain or attack cancer. The two categories significantly overlap: many herbs modulate both immune function and inflammation. These include many of our “adaptogenic” herbs, such as withania, ginseng, eleutherococcus, schisandra, licorice, and many medicinal mushrooms, as well as echinacea and garlic. Herbs more focused on regulating inflammation include turmeric (and its curcuminoids), licorice, willow, etc.

Extra-cellular Matrix and Connective Tissue

There are herbs that support the proper formation and maintain the strength of the extra-cellular matrix and connective tissues. The extra-cellular matrix, or ECM, is a network of fibrous proteins and gels (composed of GAGs) filling the space between our cells, organs, and tissues.  A healthy ECM defends against tumor cells trying to infiltrate into surrounding tissue and migrate into other parts of the body. Like bacteria, tumors produce an enzyme called Hyaluronidase, which breaks down hyaluronan. Hyaluronan is a GAG produced by the mesothelial (and other) cells. Hyaluronan is a significant component of the ECM. Among many roles, the ECM creates a barrier that prevents the infiltration of bacteria and tumor cells into tissues. Within one of the many active phytochemicals in echinacea is a substance that inhibits the activity of hyaluronidase, thereby interfering with bacteria’s (and likely cancer cells’) ability to cut through the ECM. Additionally there are herbs that help promote healthy wound-healing, modulating the process of fibrosis. This could potentially reduce the runaway formation of scar tissue and fibrous plaques in the lungs or the mesothelium. Gotu Kola (Centella asiatica) is an example of a herb that helps with healthy wound-healing.

Therefore, the overall aim is to select herbs that will promote the mesothelium’s natural function and address presenting symptoms. The herbs should support its immune capacity, improve its ability to clear particulates and unwanted cells, enhance the access of immune cells to the tumor, and support a healthy extra-cellular matrix (to inhibit tumors from growing into healthy tissue and migrating). The herbs should be carefully combined with more general strategies, herbal and conventional, for addressing cancer.

Prevention.

If you have been exposed to asbestos, there may be concrete steps you can take to mitigate the damage and decrease the risk of developing mesothelioma. I’ve outlined my thought below. Additionally, though I have not investigated this, a vaccine for those exposed to asbestos is being developed in the Netherlands.

First and foremost, avoidance of exposure to asbestos. If you have any suspicion that your house may contain asbestos, find a local professional trained in asbestos removal and remediation. When installing a geothermal heating system at my grandmother’s (thereby replacing the oil heater with  geothermal system driven by 100% wind produced electricity), we found asbestos insulating many of the pipes in the basement. With careful containment, much of it was removed and the rest was covered with a protective coating.

Second, the general recommendations for preventing cancer, with a focus on respiratory health, would apply.  These include eating a diet comprised of natural foods and avoiding  processed foods.  A diet low in sugar and refined carbs with plenty of vegetables, fruits, and high-quality fats and proteins (whether vegetable or animal). Whatever diet you choose, the key is to minimize inflammatory foods, to maximize anti-oxidant rich foods, and to avoid blood-sugar issues. It is also important to exercise, along with pro-actively managing stress and minimizing exposure to environmental toxicity (from pesticides, herbicides, plastics, paints, and air pollution.) It may be prudent to avoid known irritants to the lungs, such as dust, talc, volatile organic compounds (such as those in paints), smog and exhaust fumes.

Third, supporting the health and detoxification of the lungs and mesothelium.  The fluid produced by the mesothelial cells is part of our defenses for protecting the lungs.  It helps to clear the cells of irritants.  Supporting this process may help in the removal of asbestos particles that have not penetrated too deeply into the mesothelial tissue. It may also reduce exacerbating irritation from other particulates. As previously outlined, there are a number of botanical medicines which could play a role in supporting this process.

Psychological and MindBody.

STRESS! Chronic stress tilts our physiology into a pro-inflammatory and immune-compromised state that is correlated with increased risk of many health conditions, including cancer. 

Psychosocial. Family, friends and social support. As a volunteer support worker for CLAN, a non-profit organization supporting all individuals affected by cancer, I am constantly aware of the benefits of support. The positive impact of basic emotional support, both one-to-one and in groups, cannot be underestimated.  Without getting into a full discussion of the impact of psychosocial factors such as stress, emotions, and support systems on health (and cancer), let’s just say that it can have a positive impact on both quality of life and on survival