Mesothelioma

Question 1

Define

Answer 1

DEFINITION: aggressive tumour of the mesothelial cells, which usually occurs in the pleura (90%) but can also occur in other sites, such as the peritoneum, pericardium and testes.

NOTE: malignant pleural mesothelioma rarely spreads to distant sites but most patients present with locally advanced disease

Question 2

Causes

Answer 2

Strongly related to ASBESTOS exposure

Question 3

Epidemiology

Answer 3

RARE

More common in ELDERLY (> 75 yrs)

Asbestos exposure is documented in 70-80% of cases

Latent period between asbestos exposure and mesothelioma may be up to 50 yrs

Question 4

Symptoms

Answer 4

MOST COMMON symptoms:

• SOB
• Chest pain (dull, diffuse and progressive)
• Weight loss

Occasionally palpable chest wall mass

Fatigue

Fever

Night sweats

Clubbing (due to underlying asbestosis (pulmonary fibrosis))

Signs of metastases (e.g. hepatomegaly, bone pain and tenderness)

Question 5

Signs

Answer 5

MOST COMMON symptoms:

• SOB
• Chest pain (dull, diffuse and progressive)
• Weight loss

Occasionally palpable chest wall mass

Fatigue

Fever

Night sweats

Clubbing (due to underlying asbestosis (pulmonary fibrosis))

Signs of metastases (e.g. hepatomegaly, bone pain and tenderness)

Question 6

Investigations

Answer 6

CXR/CT

• Shows pleural effusion
• May show a pleural mass and rib destruction

MRI and PET

Pleural fluid - can be sent for cytological analysis and may be blood-stained

Pleural biopsy