Mesothelioma Clinical Presentation

  • Author: Winston W Tan, MD; Chief Editor: Jules E Harris, MD   more...
 
Updated: Dec 6, 2011
 

History

  • Dyspnea and nonpleuritic chest wall pain are the most common presenting symptoms of malignant mesothelioma. (Approximately 60-90% of patients have symptoms of chest pain or dyspnea.)
    • Chest radiographs show obliteration of the diaphragm, nodular thickening of the pleura, decreased size of the involved chest, radiolucent sheetlike encasement of the pleura, or a combination of these.
    • A loculated effusion is present in more than 50% of patients, and a major portion of the pleura is opacified by the effusion.
  • Chest discomfort, pleuritic pain, easy fatigability, fever, sweats, and weight loss are the other common accompanying symptoms.
  • Patients may also be asymptomatic, with evidence of a pleural effusion noted incidentally on physical examination or by chest radiograph.
  • Metastatic disease is uncommon at presentation, and contralateral pleural abnormalities are usually secondary to asbestos-related pleural disease rather than metastatic disease.
  • Despite the ban or reduction of asbestos in the 1960s, incidence of mesothelioma continues to increase because patients develop mesothelioma 20-40 years after asbestos exposure. The long latency period adds to the complexities of early diagnosis and treatment of the condition.
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Physical

  • In patients with malignant mesothelioma, physical findings of pleural effusion are usually noted upon percussion and auscultation.
  • In rare cases, malignant mesothelioma manifests as cord compression, brachial plexopathy, Horner syndrome, or superior vena cava syndrome. Death is usually due to infection or respiratory failure from the progression of mesothelioma.
  • Primary sites include the pleura (87%), the peritoneum (5.1%), the pericardium (0.4%), and the right side of the thorax (more so than the left side, by a right-to-left ratio of 1.6:1).
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Causes

  • A substantial proportion of patients were exposed to asbestos in asbestos mills, shipping yards, mines, or their homes.
  • The crocidolite in asbestos is associated with mesothelioma in miners, manufacturers (using asbestos), and heating and construction workers. The rod-shaped amphiboles are more carcinogenic than the chrysotile.
  • Malignant mesothelioma has also been linked to therapeutic radiation using thorium dioxide and zeolite, a silicate in the soil.
  • An etiological role for simian virus 40 in malignant mesothelioma has also been suggested. Asbestos exposure alone was associated with malignant mesothelioma, but simian virus 40 alone was not; thus, some epidemiological evidence exists that simian virus 40 is a possible cocarcinogen. Its direct role at this point is still controversial.[3]
  • Interleukin 8 has direct growth-potentiating activity in mesothelial cell lines.
  • Loss of one copy of chromosome 22 is the single most common karyotypic change in malignant mesothelioma. Other chromosomal changes commonly observed include 1p, 3p, 9p, and 6q. Several changes in the tumor suppressor gene p16 (CDKN2A) and p14 (ARF) and loss of function of neurofibromin 2 (NF2) or merlin are altered.[4]
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Contributor Information and Disclosures
Author

Winston W Tan, MD  Assistant Professor of Medicine, Mayo Medical School; Consulting Staff, Mayo Group Practices

Winston W Tan, MD is a member of the following medical societies: American College of Physicians, American Society of Clinical Oncology, American Society of Hematology, Philippine Medical Association, and Texas Medical Association

Disclosure: Medivation Grant/research funds Other; Oncogenix Grant/research funds Other; Genentech Grant/research funds Other

Specialty Editor Board

Michael Perry, MD, MS, MACP  Nellie B Smith Chair of Oncology Emeritus, Director, Division of Hematology and Medical Oncology, Deputy Director, Ellis Fischel Cancer Center, University of Missouri-Columbia School of Medicine

Michael Perry, MD, MS, MACP is a member of the following medical societies: Alpha Omega Alpha, American Association for Cancer Research, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society of Clinical Oncology, American Society of Hematology, International Association for the Study of Lung Cancer, and Missouri State Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Benjamin Movsas, MD  Vice-Chairman, Department of Radiation Oncology, Fox Chase Cancer Center

Benjamin Movsas, MD is a member of the following medical societies: American College of Radiology, American Radium Society, and American Society for Therapeutic Radiology and Oncology

Disclosure: Nothing to disclose.

Rajalaxmi McKenna, MD, FACP  Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems

Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis

Disclosure: Nothing to disclose.

Chief Editor

Jules E Harris, MD  Clinical Professor of Medicine, Division of Hematology/Medical Oncology, Department of Internal Medicine, University of Arizona College of Medicine; Consulting Staff, Arizona Cancer Center

Jules E Harris, MD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Association of Immunologists, American Society of Hematology, and Central Society for Clinical Research

Disclosure: GlobeImmune Salary Consulting

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