Article thumbnail

Malignant mesothelioma

By Alastair J Moore, Robert J Parker and John Wiggins

Abstract

Malignant mesothelioma is a fatal asbestos-associated malignancy originating from the lining cells (mesothelium) of the pleural and peritoneal cavities, as well as the pericardium and the tunica vaginalis. The exact prevalence is unknown but it is estimated that mesotheliomas represent less than 1% of all cancers. Its incidence is increasing, with an expected peak in the next 10–20 years. Pleural malignant mesothelioma is the most common form of mesothelioma. Typical presenting features are those of chest pain and dyspnoea. Breathlessness due to a pleural effusion without chest pain is reported in about 30% of patients. A chest wall mass, weight loss, sweating, abdominal pain and ascites (due to peritoneal involvement) are less common presentations. Mesothelioma is directly attributable to occupational asbestos exposure with a history of exposure in over 90% of cases. There is also evidence that mesothelioma may result from both para-occupational exposure and non-occupational "environmental" exposure. Idiopathic or spontaneous mesothelioma can also occur in the absence of any exposure to asbestos, with a spontaneous rate in humans of around one per million. A combination of accurate exposure history, along with examination radiology and pathology are essential to make the diagnosis. Distinguishing malignant from benign pleural disease can be challenging. The most helpful CT findings suggesting malignant pleural disease are 1) a circumferential pleural rind, 2) nodular pleural thickening, 3) pleural thickening of > 1 cm and 4) mediastinal pleural involvement. Involvement of a multidisciplinary team is recommended to ensure prompt and appropriate management, using a framework of radiotherapy, chemotherapy, surgery and symptom palliation with end of life care. Compensation issues must also be considered. Life expectancy in malignant mesothelioma is poor, with a median survival of about one year following diagnosis

Topics: Review
Publisher: BioMed Central
OAI identifier: oai:pubmedcentral.nih.gov:2652430
Provided by: PubMed Central

Suggested articles

Citations

  1. (1995). A proposed new international TNM staging system for malignant pleural mesothelioma. From the International Mesothelioma Interest Group. Chest
  2. (2007). A randomised controlled trial of intervention site radiotherapy in malignant pleural mesothelioma. Radiother Oncol
  3. (2007). A randomised Phase III trial of active symptom control with or without chemotherapy in the treatment of patients with malignant pleural mesothelioma. The Medical Research Council/British Thoracic Society MSO 1 Trial [abstract]. Thorax
  4. (2005). A: Asbestos exposure, pleural mesothelioma, and serum osteopontin levels.
  5. (2007). A: Multidisciplinary treatment of malignant pleural mesothelioma. Oncologist
  6. (2005). Aaronson SA: Evidence against a role for SV40 in human mesothelioma. Cancer Res
  7. (2004). Agarwal R: Pleurodesis for malignant pleural effusions. Cochrane Database Syst Rev
  8. (2005). AJ: Improved survival with VATS pleurectomy-decortication in advanced malignant mesothelioma. Eur J Surg Oncol
  9. (1995). Alatas F: CT-guided pleural needle biopsy in the diagnosis of malignant mesothelioma.
  10. (1998). Albelda SM, Alavi A: Metabolic imaging of malignant pleural mesothelioma with fluorodeoxyglucose positron emission tomography. Chest
  11. (2005). and malignant pleural mesothelioma. Lung Cancer
  12. (2008). Application of immunohistochemistry to the diagnosis of malignant mesothelioma. Arch Pathol Lab Med
  13. (1989). Autoimmune haemolytic anaemia associated with malignant peritoneal mesothelioma. Acta Clin Belg
  14. (2008). AW: Management of malignant pleural effusions using the Pleur(x) catheter. Ann Thorac Surg
  15. (2006). Bedrossian CW: The pathogenesis of mesothelioma. Semin Diagn Pathol
  16. (2003). BTS guidelines for the management of malignant pleural effusions. Thorax
  17. (2007). BTS statement on malignant mesothelioma in the UK,
  18. (1997). C: Latency periods in asbestos-related mesothelioma of the pleura.
  19. (1996). Constantopoulos SH: Malignant pleural mesothelioma from nonoccupational asbestos exposure in Metsovo (north-west Greece): slow end of an epidemic? Eur Respir J
  20. (1991). Cram I: The role of palliative radiotherapy in malignant mesothelioma.
  21. (1990). Cruickshank DG: The treatment of malignant mesothelioma of the pleura: review of a 5-year experience, with special reference to radiotherapy.
  22. (2007). CW: Dose-dependent pulmonary toxicity after postoperative intensity-modulated radiotherapy for malignant pleural mesothelioma.
  23. (2003). CW: Intensity-modulated radiotherapy following extrapleural pneumonectomy for the treatment of malignant mesothelioma: clinical implementation.
  24. (1991). Deterioration in lung function following hemithorax irradiation for pleural mesothelioma.
  25. (1960). Diffuse pleural mesothelioma and asbestos exposure in the North Western Cape Province.
  26. (1994). DL: Radiotherapy in the treatment of malignant mesothelioma of the pleura, with special reference to its use in palliation. Australas Radiol
  27. (1995). E: Prevention of tumour seeding following thoracoscopy in mesothelioma by prophylactic radiotherapy. Clin Oncol (R Coll Radiol)
  28. (2006). EH: Fatal pneumonitis associated with intensity-modulated radiation therapy for mesothelioma.
  29. (2007). EH: Influence of radiotherapy technique and dose on patterns of failure for mesothelioma patients after extrapleural pneumonectomy.
  30. (2006). Erturk H: Computed tomography findings in 66 patients with malignant pleural mesothelioma due to environmental exposure to asbestos. Clin Imaging
  31. (2004). Evidence against a role for SV40 infection in human mesotheliomas and high risk of false-positive PCR results owing to presence of SV40 sequences in common laboratory plasmids. Lancet
  32. (1999). F: Mineral fibre analysis and routes of exposure to asbestos in the development of mesothelioma in an English region. Occup Environ Med
  33. (1998). Finger clubbing in malignant mesothelioma and benign asbestos pleural disease. Respir Med
  34. (2004). Girling DJ: BTS randomised feasibility study of active symptom control with or without chemotherapy in malignant pleural mesothelioma: ISRCTN 54469112. Thorax
  35. (1998). Good symptom relief with palliative MVP (mitomycin-C, vinblastine and cisplatin) chemotherapy in malignant mesothelioma. Ann Oncol
  36. (2000). Gwyther SG: New guidelines to evaluate the response to treatment in solid tumors.
  37. (2003). Hellstrom I: Mesothelin-family proteins and diagnosis of mesothelioma. Lancet
  38. (2005). Hellstrom I: Soluble mesothelin-related protein – a blood test for mesothelioma. Lung Cancer
  39. (2008). HL: Current state and future directions of pleural mesothelioma imaging. Lung Cancer
  40. (2002). I: Lung diseases due to environmental exposures to erionite and asbestos in Turkey. Toxicol Lett
  41. (2004). IE: The palliative benefits of MVP (mitomycin C, vinblastine and cisplatin) chemotherapy in patients with malignant mesothelioma. Ann Oncol
  42. (1999). JE: Malignant pleural effusions: treatment with smallbore-catheter thoracostomy and talc pleurodesis. Radiology
  43. (1995). JR: Continuing increase in mesothelioma mortality in Britain. Lancet
  44. (2005). JT: Mesothelioma mortality in Great Britain from 1968 to 2001. Occup Med (Lond)
  45. (1982). JT: Radiation therapy in the management of patients with mesothelioma.
  46. (2008). Klein JS: Recent advances in the diagnosis and management of malignant pleural effusions. Mayo Clin Proc
  47. (2007). Lassalle P: Utility of osteopontin and serum mesothelin in malignant pleural mesothelioma diagnosis and prognosis assessment. Clin Cancer Res
  48. (2008). Malignant mesothelioma 2008. Curr Opin Pulm Med
  49. (1997). Malignant mesothelioma in south east England: clinicopathological experience of 272 cases. Thorax
  50. Malignant Pleural Mesothelioma. Clinical Respiratory Medicine. Mosby 2nd edition.
  51. (2008). Mesothelioma and asbestos. Regul Toxicol Pharmacol
  52. (2003). MR: Current controversies regarding the role of asbestos exposure in the causation of malignant mesothelioma: the need for an evidence-based approach to develop medicolegal guidelines. Ann Diagn Pathol
  53. (2006). Multimodality approach in management of malignant pleural mesothelioma.
  54. (2004). Nowak AK: Modified RECIST criteria for assessment of response in malignant pleural mesothelioma. Ann Oncol
  55. (2004). O'Byrne KJ: Malignant pleural mesothelioma – an update.
  56. (2007). O'Rourke N: Drain site radiotherapy in malignant pleural mesothelioma: a wasted resource. Eur Respir J
  57. (2006). Olschewski H: Mesothelioma mortality in Europe: impact of asbestos consumption and simian virus 40. Orphanet J Rare Dis
  58. (2006). Pastan I: Megakaryocyte potentiation factor cleaved from mesothelin precursor is a useful tumor marker in the serum ofOrphanet
  59. (1996). Pastan I: Molecular cloning of mesothelin, a differentiation antigen present on mesothelium, mesotheliomas, and ovarian cancers.
  60. (2008). Phase II study of pemetrexed in combination with carboplatin in patients with malignant pleural mesothelioma (MPM). Ann Oncol
  61. (2000). Phase II study of vinorelbine in patients with malignant pleural mesothelioma.
  62. (2003). Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma.
  63. (1997). Pleurectomy/decortication in the setting of multimodality treatment for diffuse malignant pleural mesothelioma. Semin Thorac Cardiovasc Surg
  64. (2006). Radiotherapy for malignant pleural mesothelioma. Cochrane Database Syst Rev
  65. (2001). RJ: A phase II trial of surgical resection and adjuvant high-dose hemithoracic radiation for malignant pleural mesothelioma. J Thorac Cardiovasc Surg
  66. (2004). RJ: Randomized trials describing lung inflammation after pleurodesis with talc of varying particle size. Am J Respir Crit Care Med
  67. (1990). RR: CT in differential diagnosis of diffuse pleural disease.
  68. (2007). S: Spontaneous peritoneal malignant mesothelioma in a geriatric japanese macaque (Macaca fuscata). Exp Anim
  69. (2007). Sardesai NY: MESOMARK: a potential test for malignant pleural mesothelioma. Clin Chem
  70. (2002). Sculier JP: Activity of chemotherapy and immunotherapy on malignant mesothelioma: a systematic review of the literature with meta-analysis. Lung Cancer
  71. (2004). Sedrakyan A: Pleural mesothelioma: little evidence, still time to do trials. Lancet
  72. (1997). Simian virus 40 and malignant mesothelioma. Thorax
  73. (2007). Simian virus 40 and mesothelioma in Great Britain. Occup Med (Lond)
  74. (1976). Simpson JC: The clinical aspects of mesothelioma.
  75. (1996). SJ: Extrapleural pneumonectomy in the multimodality therapy of malignant pleural mesothelioma. Results in 120 consecutive patients. Ann Surg
  76. (2008). Soluble mesothelin-related peptide level elevation in mesothelioma serum and pleural effusions. Ann Thorac Surg
  77. (2006). Soluble mesothelinrelated peptides in the diagnosis of malignant pleural mesothelioma. Am J Respir Crit Care Med
  78. (2007). Spiliopoulos A: Multicenter trial of neo-adjuvant chemotherapy followed by extrapleural pneumonectomy in malignant pleural mesothelioma. Ann Oncol
  79. (2004). T: Evaluation of pleural disease with 18-fluorodeoxyglucose positron emission tomography imaging. Chest
  80. (2007). T: Pemetrexed disodium in combination with cisplatin versus other cytotoxic agents or supportive care for the treatment of malignant pleural mesothelioma. Cochrane Database Syst Rev
  81. The expected burden of mesothelioma mortality
  82. (2000). The long-term morbidity of pleuroperitoneal shunts in the management of recurrent malignant effusions. Eur J Cardiothorac Surg
  83. (2006). The MARS trial: mesothelioma and radical surgery. Interact Cardiovasc Thorac Surg
  84. (2007). The role of radiotherapy in the treatment of malignant pleural mesothelioma. Clin Oncol (R Coll Radiol)
  85. (1995). Viallat JR: Prevention of malignant seeding after invasive diagnostic procedures in patients with pleural mesothelioma. A randomized trial of local radiotherapy. Chest
  86. (2008). VW: Extrapleural pneumonectomy versus pleurectomy/decortication in the surgical management of malignant pleural mesothelioma: results in 663 patients. J Thorac Cardiovasc Surg
  87. (2006). VW: Induction chemotherapy, extrapleural pneumonectomy, and postoperative high-dose radiotherapy for locally advanced malignant pleural mesothelioma: a phase II trial. J Thorac Oncol
  88. (2004). WR: Malignant pleural mesothelioma: evaluation with CT, MR imaging, and PET. Radiographics
  89. (1998). Xiao GH: A multi-institutional study confirms the presence and expression of simian virus 40 in human malignant mesotheliomas. Cancer Res
  90. (2007). YC: Biomarkers for mesothelioma. Curr Opin Pulm Med
  91. (2004). Zellos LS: Prevention, early detection, and management of complications after 328 consecutive extrapleural pneumonectomies. J Thorac Cardiovasc Surg

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.