mesothelioma

Question 1

what is mesothelioma?

Answer 1

Mesothelioma is a cancer of the mesothelial layer of the pleural cavity that is strongly associated with asbestos exposure

Malignancy of mesothelial cells of pleura
Metastases to contralateral lung and peritoneum
Right lung affected more often than left

Question 2

what are features of mesothelioma?

Answer 2

Dyspnoea, weight loss, chest wall pain
Clubbing
30% present as painless pleural effusion
Only 20% have pre-existing asbestosis
History of asbestos exposure in 85-90%, latent period of 30-40 years

Question 3

what are investigations for mesothelioma?

Answer 3

CXR- pleural effusion or pleural thickening

pleural CT

pleural effusion- MC+S, biochem + cytology

local anaesthetic thoracoscopy to investigate cytology negative exudative effusions- high diagnostic yield

image-guided pleural biopsy if area of pleural nodularity seen on CT

Question 4

what is the management of mesothelioma?

Answer 4

Symptomatic
Industrial compensation
Chemotherapy, Surgery if operable
Prognosis poor, median survival 12 months