Mesothelioma

“A malignant growth of the mesothelial cells of the pleura, or more rarely the peritoneum or pericardium“

Risk Factors

• Asbestos

Aetiology

• Asbestos Exposure

Pathophysiology

1. Exposure to Asbestos
2. Long latent period of 20-40 years
3. Local mass + pleural effusion

Clinical Presentation

• Dyspnoea, weight loss, recurrent pleural effusions (which present with breathlessness), finger clubbing
• Signs of metastasis / invasion of local structures à chest pain, lymphadenopathy, bone pain, abdominal obstruction, hepatomegaly

Investigations

• Bloods:
  • Cytology – often negative
• Imaging:
  • Chest X-Ray – Pleural nodularity / effusion / plaques
  • Chest CT – Pleural nodularity / thickening of >1cm
• Special:
  • Pleural Aspiration – blood stained plural fluid
  • Thoracoscopy – often used for cytology negative exudate effusions. Histological examination

Management

• Management often has a poor prognosis

• Conservative: n/a
• Medical:
  • Chemotherapy – Pemetrexed + Cisplatin
• Surgical: n/a

Complications

• Depression
• Recurrent Pleural Effusions