Mesothelioma

People working in Asbestose industry have high risk of developing Mesothelioma. Most of the medical students have never gone through this case but knowing how to diagnose and treat it is very essential.

How to Diagnose

• Unilateral, nonpleuritic chest pain and dyspnea.
• Distant (> 20 years earlier) history of exposure to asbestos.
• Pleural effusion or pleural thickening or both on chest radiographs.
• Malignant cells in pleural fluid or tissue biopsy.
  
  

These are primary tumors arising from the surface lining of the pleura (80% of cases) or peritoneum (20% of cases). About three-fourths of pleural mesotheliomas are diffuse (usually malignant) tumors, and the remaining one-fourth are localized (usually benign). Men outnumber women by a 3:1 ratio. Numerous studies have confirmed the association of malignant pleural mesothelioma with exposure to asbestos (particularly the crocidolite form).

The lifetime risk to asbestos workers of developing malignant pleural mesothelioma is about 8%. Sixty to 80 percent of patients with malignant mesothelioma report a history of asbestos exposure. The latent period between exposure and onset of symptoms ranges from 20 to 40 years. The clinician should inquire about asbestos exposure through mining, milling, manufacturing, shipyard work, insulation, brake linings, building construction and demolition, roofing materials, and a variety of asbestos products (pipe, textiles, paint, tile, gaskets, panels). Although cigarette smoking significantly increases the risk of bronchogenic carcinoma in asbestos workers and aggravates asbestosis, there is no association between smoking and mesothelioma.

Symptoms and Signs

• age of onset 60 years.
• shortness of breath
• nonpleuritic chest pain, and
• weight loss.

Complications

Local invasion of thoracic structures may cause superior vena cava syndrome, hoarseness, Horner’s syndrome, and dysphagia. Paraneoplastic syndromes associated with mesothelioma include thrombocytosis, hemolytic anemia, disseminated intravascular coagulopathy, and migratory thrombophlebitis.

Treatment

surgery, radiotherapy, chemotherapy, and a combination of methods has been attempted but is generally unsuccessful. Some surgeons believe that extrapleural pneumonectomy is the preferred surgical approach for patients with early stage disease. Drainage of pleural effusions, pleurodesis, radiation therapy, and even surgical resection may offer palliative benefit in some patients.