Mesothelioma

Most cases of mesothelioma are caused by asbestos fibres. Amphibole asbestos fibre has a higher risk of mesothelioma than amphibole fibre. 

The median latency between exposure to asbestos and death from mesothelioma is 32 years  

Presentation: 
  • Chest pain – may be dull, heavy, aching or pleuritic 
  • Dyspnoea
  • Less commonly: 
    • Cough 
    • Abdominal pain
    • Pneumothorax 

Metastatic symptoms are uncommon

Diagnosis 
  • History – look for occupational asbestos exposure
  • Examination 
  • Investigations
    • CXR – may show 
      • Pleural thickening 
      • Pleural effusion 
    • CT chest 
    • Pleural tap
    • If doubt about diagnosis - biopsy 

Management
  • Early pleurodesis for symptomatic relief 
  • Palliative radiotherapy 
  • Possible chemotherapy 
  • Make patients aware of medicolegal aspects 
  • Radical surgery only indicated as part of a clinical trial 

Prognosis 
Median survival once diagnosed is 8 to 14 months 

Small print gem: mesothelioma may also be peritoneal but this is rarer – there are 12 cases of pleural mesothelioma for each case of peritoneal mesothelioma


References

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