Mesothelioma_Flashcards

Question 1

Definition

Answer 1

Malignant mesothelioma is an aggressive epithelial neoplasm arising from the lining of the lung, abdomen, pericardium, or tunica vaginalis. Asbestos exposure is the principal cause.

Question 2

Pathophysiology

Answer 2

Asbestos fibers cause chronic inflammation, DNA damage, and eventual malignant transformation. Key mutations include BRCA1-associated protein-1 (BAP1) and NF2 genes.

Question 3

Epidemiology

Answer 3

Annual incidence in the US is approximately 3200 cases. It predominantly affects older adults (60-85 years) and is more common in men (3:1 male-to-female ratio).

Question 4

History

Answer 4

Patients often present with shortness of breath, chest pain, fatigue, or dry cough. A history of asbestos exposure is common, with a latency period of 20-40 years.

Question 5

Examination

Answer 5

Examination findings may include diminished breath sounds, dullness to percussion, or signs of pleural effusion. Constitutional symptoms like weight loss and fatigue are common.

Question 6

Investigations - Bedside

Answer 6

Thoracentesis and pleurodesis may provide diagnostic clues and symptomatic relief.

Question 7

Investigations - Bloods

Answer 7

Routine blood work shows baseline organ function. Elevated platelet count or anemia may suggest advanced disease.

Question 8

Investigations - Imaging

Answer 8

Chest X-rays reveal pleural thickening or effusion. CT scans can detect pleural abnormalities and lymph node involvement.

Question 9

Investigations - Special Tests

Answer 9

Biopsy via video-assisted thoracoscopy is the gold standard. Immunohistochemical markers like calretinin confirm the diagnosis.

Question 10

Management - Conservative

Answer 10

Smoking cessation and workplace safety education are crucial preventive measures.

Question 11

Management - Medical

Answer 11

Chemotherapy (cisplatin + pemetrexed) and immune checkpoint inhibitors (nivolumab + ipilimumab) are mainstays of treatment for inoperable cases.

Question 12

Management - Surgical

Answer 12

Surgical options include extrapleural pneumonectomy (EPP) or pleurectomy with decortication for selected operable patients.

Question 13

Risks of Treatments

Answer 13

Chemotherapy can lead to hematological toxicity. Radiation therapy risks include pneumonitis and skin erythema.

Question 14

Benefits of Treatments

Answer 14

Chemotherapy improves survival and quality of life. Palliative interventions relieve symptoms like dyspnea.

Question 15

Medical and Laboratory Sciences

Answer 15

Biomarkers such as soluble mesothelin-related peptides (SMRP) may aid diagnosis and prognosis.

Question 16

Prognosis

Answer 16

Median survival is poor. The 5-year survival rate ranges from 9.4% (distant disease) to 24.2% (localized disease).

Question 17

Complications

Answer 17

Complications include surgical morbidity, radiation pneumonitis, and disease-related local invasion or metastasis.

Question 18

Differentials

Answer 18

Differentials include lung cancers, benign mesothelial hyperplasia, and metastatic diseases. History and imaging are key in differentiation.

Question 19

Cheat Sheet/Buzz Words

Answer 19

Buzzwords: Asbestos exposure, pleural effusion, mesothelin biomarkers, extrapleural pneumonectomy, checkpoint inhibitors.