Malignant pleural mesothelioma accounts for most malignant mesotheliomas; it is a rare malignancy with an annual incidence of 3200 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.
Despite advances in treatment, malignant pleural mesothelioma remains a highly lethal malignancy with few long-term survivors.
Operable malignant disease should receive trimodal therapy with chemotherapy, surgery, and hemithoracic radiation therapy.
Inoperable malignant disease should receive combination chemotherapy or immune checkpoint inhibitor therapy.
Malignant mesothelioma is an aggressive epithelial neoplasm arising from the lining of the lung, abdomen, pericardium, or tunica vaginalis. It is one of the few cancers related directly to an environmental exposure; asbestos is the chief causative agent.
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
- constitutional symptoms
- abdominal distention and/or pain
- asbestos exposure
- age 60 to 85 years
- asbestos exposure during home maintenance and renovation
- male sex
- radiation exposure
- genetic predisposition
- simian virus 40 (SV-40)
1st investigations to order
- chest x-ray
- CT scan of the chest and upper abdomen with intravenous contrast
Investigations to consider
- pleural biopsy
- video-assisted thoracoscopic surgery (VATS)
- chest MRI
- PET scan
- cervical mediastinoscopy
- pulmonary function tests
- basic metabolic panel
inoperable or recurrent disease
- Benign reactive mesothelial hyperplasia
- Benign asbestos-related pleural reactions
- Non-small cell lung cancer
- NCCN clinical practice guidelines in oncology: mesothelioma: pleural
- Malignant pleural mesothelioma
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