Summary
Definition
History and exam
Key diagnostic factors
- family history
- history of asbestos exposure
- age between 60 and 85 years
- shortness of breath
- diminished breath sounds
- dullness to percussion
Other diagnostic factors
- male sex
- chest pain
- cough
- constitutional symptoms
- abdominal distension and/or pain
Risk factors
- asbestos exposure
- asbestos exposure during home maintenance and renovation
- age 60 to 85 years
- male sex
- radiation exposure
- genetic predisposition
- simian virus 40 (SV-40)
Diagnostic investigations
1st investigations to order
- chest x-ray
- CT scan of the chest and upper abdomen with intravenous contrast
Investigations to consider
- thoracentesis
- pleural biopsy
- video-assisted thoracoscopic surgery (VATS)
- immunohistochemistry
- chest MRI
- PET scan
- cervical mediastinoscopy
- pulmonary function tests
- FBC
- basic metabolic panel
Treatment algorithm
operable disease
inoperable or recurrent disease
Contributors
Authors
Anish Thomas, MD, MBBS
Staff Clinician
Center for Cancer Research
Thoracic and Gastrointestinal Oncology Branch
National Cancer Institute
Bethesda
MD
Disclosures
AT declares that he has no competing interests.
Jaydira del Rivero, MD
Medical Oncology Branch
Center for Cancer Research
National Cancer Institute
Bethesda
MD
Disclosures
JdR declares that he has no competing interests.
Mary Hesdorffer, MS, APRN
Nurse Practitioner
Executive Director
Mesothelioma Applied Research Foundation
Alexandria
VA
Disclosures
MH declares that she has no competing interests.
Acknowledgements
Dr Anish Thomas, Dr Jaydira del Rivero, and Mrs Mary Hesdorffer would like to gratefully acknowledge Dr Robert Taub and Dr Chris R. Kelsey, the previous contributors to this topic.
Disclosures
RT and CRK declare that they have no competing interests.
Peer reviewers
Marc de Perrot, MD, MSc
Associate Professor of Surgery
University of Toronto
Division of Thoracic Surgery
Toronto General Hospital
Ontario
Canada
Disclosures
MdP is an author of a reference cited in this topic.
Nicholas J. Vogelzang, MD
Chair and Medical Director
Developmental Therapeutics
Co-Chair
GU Committee
US Oncology Research
Comprehensive Cancer Centers of Nevada
Las Vegas
NV
Disclosures
NJV is a past chair of a US-based mesothelioma foundation. NJV is an author of a number of references cited in this topic.
Tom Treasure, MD, MS FRCS, FRCP
Professor of Cardiothoracic Surgery (Honorary)
Clinical Operational Research Unit
Department of Mathematics
University College London
London
UK
Disclosures
TT declares that he has no competing interests.
Differentials
- Benign reactive mesothelial hyperplasia
- Benign asbestos-related pleural reactions
- Non-small cell lung cancer
More DifferentialsGuidelines
- NCCN clinical practice guidelines in oncology: malignant pleural mesothelioma
- Treatment of malignant pleural mesothelioma
More Guidelines
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