Mesothelioma

Risk factors

• Asbestosis
  • Very strong risk factor
  • Latency period 15-40 years between exposure and disease

Pathophysiology

• Arises from the mesothelial cells lining the parietal and visceral pleura
• Subtypes
  • Epithelial (favourable prognosis)
  • Sarcomatoid
  • Mixed

Presentation

• Dyspnoea
• Cough
• Pleural effusion
• Weight loss
• Chest pain
• Fever

Workup

• CXR
• CT
• MRI
• FGD-PET
• TTE - determine cardiac involvement and function
• Pleural biopsy

Staging

• TNM

Surgery

• Best operative candidates
  • Early stage disease
  • Pure epithelial histology
  • Good functional status
• Operation
  • Complete macroscopic resection of tumour
  • Either
    • Extra-pleural pneumonectomy - resection of entire lung, including the visceral and parietal pleura and the diaphragm +/- pericardium through a large posterolateral thoracotomy - most extensive, mortality 5-20%
    • Extended pleurectomy and decortication - resection of the parietal and visceral pleura and the diaphragm +/- pericardium through a large posterolateral thoracotomy - somewhat less extensive but much lower morbidity - now more common

Palliative care

• Pleural indwelling catheters
• Pleurodesis