Mesothelioma

Question 1

what is mesothelioma?

Answer 1

Malignant mesothelioma is an aggressive epithelial neoplasm arising from the lining of the lung, abdomen, pericardium, or tunica vaginalis. It is one of the few cancers related directly to an environmental exposure; asbestos is the chief causative agent.

Question 2

what is the epidemiology of mesothelioma?

Answer 2

Aggressive
Male
Older age
20-40 years after exposure to asbestos

Question 3

what is the aetiology of mestheliomas?

Answer 3

Asbestos fibres (blue - crocidolite, brown - amosite, white - chrysotile)

Question 4

what are the risk factor for mesothelioma?

Answer 4

Asbestos exposure - 20-40 year latent period
asbestos exposure during home maintenance and renovation
age 60 to 85 years
male sex

Question 5

what is the pathophysiology of mesothelioma?

Answer 5

Asbestos exposure is considered the primary causal factor. Studies suggest that exposure to asbestos fibres results in recruitment and activation of alveolar macrophages and neutrophils, with subsequent generation, possibly iron-catalysed, of reactive oxygen and nitrogen species. Chronic inflammation and oxidative stress may culminate in DNA damage, alterations in gene expression (proto-oncogenes and tumour suppressor genes), and eventual malignant transformation. However, exactly how these asbestos-induced changes foster the development of malignant pleural mesothelioma remains a topic of considerable investigation and uncertainty.

Question 6

what are the key presentations of mesothelioma?

Answer 6

Shortness of breath 
chest pain
Unilateral pleural effusion
Pleural thickening 
family history
history of asbestos exposure
age between 60 and 85 years

Question 7

what are the first line and gold standard investigations for mesothelioma?

Answer 7

chest x-ray

CT scan of the chest and upper abdomen with intravenous contrast

Question 8

what are the differential diagnoses for mesothelioma?

Answer 8

Benign reactive mesothelial hyperplasia
Benign asbestos-related pleural reactions
Non-small cell lung cancer

Question 9

how is mesothelioma managed?

Answer 9

Chemo?, surgery (rare, not curative)

Palliative care

Question 10

how is mesothelioma monitored?

Answer 10

After definitive treatment for malignant pleural mesothelioma, often consisting of surgery, radiotherapy, and chemotherapy, patients should be monitored closely for treatment-related toxicity, such as post-thoracotomy pain, radiation pneumonitis, and chemotherapy-induced haematological toxicity.

Question 11

what are the complications of mesothelioma?

Answer 11

Surgical morbidity
Acute radiation morbidity
Radiation pneumonitis

Question 12

what is the prognosis of mesothelioma?

Answer 12

8-12 months average survival

Question 13

what is asbestosis?

Answer 13

pleural plaque, persistent pleural effusion, pleural fibrosis, diffuse interstitial pulmonary fibrosis, lung cancer, mesothelioma