Lung Cancer: Mesothelioma

Question 1

Definition

Answer 1

epithelial malignancy of the mesothelial cells of the pleura covering the lungs

Question 2

Epidemiology

Answer 2

Increasing age: >60 years old
Male gender

Question 3

Aetiology

Answer 3

Asbestos exposure (MC) = malignancy occurring 20-40 years after exposure
Radiotherapy,
Genetics,
Simian virus 40

Question 4

Signs

Answer 4

Finger clubbing
Reduced breath sounds
Stony dull percussion: suggests a pleural effusion
Ascites: if peritoneal disease is present

Question 5

Symptoms

Answer 5

SOB
Cough
Pleuritic chest pain or chest wall pain
Constitutional symptoms:
- Fatigue,
- Fever,
- Night sweats,
- Weight loss

Question 6

Diagnosis

Answer 6

CXR
- unilateral pleural effusion
- reduced lung volumes
- pleural thickening
- lower zone interstitial fibrosis for asbestos
FIRST LINE = Contrast enhanced CT chest
- pleural thickening,
- pleural plaques
- enlarged lymph nodes
GOLD STANDARD = Biopsy

Question 7

Treatment (Operable)

Answer 7

Surgery
- Extrapleural pneumonectomy
- Pleurectomy with decortication
- Rarely curative

+/- Chemotherapy
- Cisplatin
- Pemetrexed
+/- Radiotherapy

Question 8

Treatment (Inoperable)

Answer 8

Chemotherapy
- Cisplatin
- Pemetrexed
+/- Radiotherapy

Question 9

Complications

Answer 9

Local invasion of structures: dysphagia; hoarseness; cord compression; Horner’s syndrome
Metastasis: metastases to the contralateral lung, peritoneum and brain