Mesothelioma

Pleural mesothelioma is a rare malignancy with an annual incidence of approximately 0.7 per 100,000 people in the US.

Largely caused by exposure to asbestos, with a 20- to 40-year latency period between exposure and the development of malignancy; the typical patient is in the sixth to ninth decade of life.

Most patients present with shortness of breath and chest pain, which on investigation is often found to be associated with unilateral pleural effusion and pleural thickening.

Germline DNA testing for BAP1 and other abnormalities should be considered during pathologic evaluation.

Patients with nonresectable disease should be evaluated for immune checkpoint inhibitor therapy, chemotherapy plus an immune checkpoint inhibitor, or chemotherapy alone if there is a contraindication to immunotherapy.

Surgery may be suitable for select patients with early-stage operable disease, but is unlikely to benefit patients with late-stage disease.

Despite advances in treatment, pleural mesothelioma remains a highly lethal malignancy with few long-term survivors.

Mesothelioma is an aggressive epithelial neoplasm arising from the lining of the lung, abdomen, pericardium, or tunica vaginalis.[1]Carbone M, Ly BH, Dodson RF, et al. Malignant mesothelioma: facts, myths, and hypotheses. J Cell Physiol. 2012 Jan;227(1):44-58. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3143206 http://www.ncbi.nlm.nih.gov/pubmed/21412769?tool=bestpractice.com It is one of the few cancers related directly to an environmental exposure; asbestos is the chief causative agent.