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 
• Pleural effusion 
• Finger clubbing – 30%
• 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

British Thoracic Society Standards of Care Committee. BTS statement on malignant mesothelioma in the UK, 2007. Thorax. 2007; 62: ii1-ii19.

Moore, A., Parker, R. and Wiggins, J. Malignant mesothelioma. Orphanet J Rare Dis. 2008; 3:34.