For Al Trevino, exposure to asbestos was part of the workday routine at the Texaco refinery in Amarillo, Tex.
"All the insulation was asbestos, on all the pipes" Al says. "At a refinery in those days, asbestos was everywhere." Everywhere, every day and all during the 18 years that Al worked at the refinery, no one knew asbestos caused cancer.
Nearly 40 years after his first day at Texaco, Al was successfully treated for mesothelioma - the cancer linked to asbestos exposure - by surgeons at Georgetown University Hospital.
Until the refinery closed in 1986, Al handled and inhaled asbestos every day he worked there. A few years after the plant closed, his wife Alberta says, the union sent out letters to the former employees asking them to get tested. "Al went in for the test and was diagnosed with asbestosis. It was not considered serious at the time."
Years passed. The Trevinos moved to Alexandria, Va., to be near family. The first sign of trouble, Al remembers, was a nagging pain beneath his left shoulder blade. Then the persistent pain spread to the left side of his chest. In the fall of 2006, fearing that it might be heart trouble, Al went to a cardiologist, who found nothing wrong. The pain persisted, and soon after New Year's Day Al went to his family physician, who ordered chest X-rays. "They showed something in his lung, and one of his ribs was already compromised" Alberta says. A pulmonary specialist ordered a CT scan and a biopsy, looked at the results and sent Al to a cancer specialist, who diagnosed mesothelioma in late February 2007. "She recommended Georgetown" Alberta says, "and referred him to Dr. Marshall."
M. Blair Marshall, MD, is chief of thoracic oncology surgery at Georgetown. "A facility like Georgetown offers patients with complex illness like mesothelioma a full spectrum of therapeutic options based on extensive specialized experience and the most advanced medical and surgical expertise" Dr. Marshall says.
"From the first day, Dr. Marshall was very kind and supportive, explaining our choices and the procedures" Alberta says. Dr. Marshall scheduled additional diagnostic tests and another biopsy and began considering options for treating Al's fast-spreading cancer.
"She was very honest in suggesting an aggressive approach to treatment" Alberta says. "She said there was only a very short window because Al's cancer was growing."
Al's cancer "mesothelioma" originates in the mesothelium, a continuous membrane that covers and protects most of the body's internal organs. It lines body cavities and has different names in different locations
within the body. The mesothelium that surrounds the heart is the pericardium. The mesothelium coating the lungs and lining the chest wall is called the pleura.
In the US, roughly 2,000 new cases of mesothelioma are diagnosed each year. By far the majority of these cases, about 80 percent, are related to asbestos exposure. Like Al Trevino, many patients do not experience symptoms until 20, 30 or even 40 years after they have breathed in the tiny, fine, strong asbestos fibers that slowly work their way through the lungs into the pleura, nearby tissue and adjacent organs. The fibers somehow disrupt normal cell function, triggering the uncontrolled growth of cancerous cells.
Al Trevino and his wife Alberta think Georgetown's Dr. Blair Marshall is just "wonderful."
Dr. Marshall told the Trevinos that the best option for stopping the spread of Al's mesothelioma was a procedure called extrapleural pneumonectomy. She would hollow out half of his chest in a procedure that removed his lung, adjacent ribs, a section of his diaphragm and part of his pericardium.
"We were dealing with a cancer that was extensive and spreading. This made Mr. Trevino a better candidate for surgery than for radiation and chemotherapy" Dr. Marshall says. "Some hospitals consider it inoperable and simply won't attempt extrapleural pneumonectomy. The procedure is very complex; it's an enormous undertaking. It requires the expertise and extensive experience of a major university-based hospital like Georgetown."
Dr. Marshall began treatment with three rounds of chemotherapy to shrink the tumor inside Al's chest. Then, in June 2007, she took out the tumor, the lung, the ribs and the rest, and then rebuilt the membrane around Al's heart.
"After the surgery, Al had two more rounds of chemotherapy" Alberta says. "That was a year ago. Now, we see Dr. Marshall every three months."
Thinking back, the Trevinos recognize junctures where a different decision might have led to a different outcome. "We were aware of the public discussion about asbestos exposure but for some reason, even though we knew he had been diagnosed with asbestosis, we didn't pay much attention to it" Alberta says. "We had our head in the sand. You know you always think it's not going to happen to you."
But when it does happen? "We are both happy that we came to Georgetown" Alberta says. "Very happy. And of course, we think Dr. Marshall is wonderful."
For more information about lung cancer and the wide range of treatment options available at Georgetown, call GeorgetownMD at 202.342.2400 or toll-free at 866.745.2633.
