eMedicine Specialties > Oncology > Carcinomas of the Lung and Other Intrathoracic Carcinomas

Mesothelioma: Follow-up

Author: Winston W Tan, MD, Assistant Professor of Medicine, Mayo Medical School; Consulting Staff, Mayo Group Practices
Contributor Information and Disclosures

Updated: Mar 4, 2009

Follow-up

Further Outpatient Care

Regular follow-up visits with an internist, pulmonary specialist, medical oncologist, and radiation oncologist are recommended.

Complications

  • The tumor recurrence rate is 50% for those treated with surgery.
  • The mortality rate secondary to surgery has improved. Even with extensive surgery, the mortality rate as reported by Huncharek et al and by Sugerbaker et al in 1996 was 3.8%.28,10

Prognosis

  • Without treatment, mesothelioma is fatal within 4-8 months.
  • With trimodality treatment, some patients have survived 16-19 months. A few have survived as long as 5 years, with rates of 14% for all types and 46% for the epithelial type. However, numbers are small.

Miscellaneous

Medicolegal Pitfalls

  • This is a difficult diagnosis to establish, so warn the pathologist if the index of suspicion is high. The diagnosis could be work-related, and a thorough discussion with the patient is warranted.
  • The legal implications are tremendous, primary prevention is important, and employers should limit the amount of asbestos exposure to the lowest levels possible. Having work standards in place is important.
  • A good working relationship among the occupational medicine specialist, the environmental hazard team, and the community at large is important.

Special Concerns

  • Other modalities of treatment being studied include gene therapy, cytokine-targeted therapy, and photodynamic therapy.
    • Gene therapy: Phase I clinical trials have shown the safety of intratumoral gene transfer of recombinant adenovirus containing herpes simplex virus thymidine kinase, followed by ganciclovir treatment. Gene therapy trials are focusing on immunostimulation and using suicide gene therapy as a tumor vaccine. Studies are developing vaccines against simian virus 40, which is thought to be carcinogenic. Gene delivery of CD 40 ligand has shown promise in murine models of malignant mesothelioma.29
    • Cytokine-targeted therapy: This includes several agents, such as interleukin 2, interferon alfa, and tumor necrosis factor. Interleukin 2 in stages I and II produces an overall survival rate of 16 months. Interferon gamma has produced a partial response rate of 19%.
    • Photodynamic therapy has been tried but has not produced improvement in survival.30
 


More on Mesothelioma

Overview: Mesothelioma
Differential Diagnoses & Workup: Mesothelioma
Treatment & Medication: Mesothelioma
Follow-up: Mesothelioma
References
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Further Reading

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Keywords

malignant mesothelioma, lung cancer, lung tumor, pulmonary cancer, pulmonary tumor, pulmonary malignancy, asbestos-related cancer, cancer of the pleura, asbestos exposure, plural cancer, mesothelioma malignancy, pleural malignant mesothelioma, sarcomatous mesothelioma, epithelial mesothelioma, mixed mesothelioma, pleural mesothelioma

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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: Roche Grant/research funds Other; Sanofi Aventis Grant/research funds Other; Genentech Grant/research funds Other; Bristol Myers Squibb Grant/research funds Other

Medical Editor

Michael Perry, MD, MS, MACP, Nellie B Smith Chair of Oncology Emeritus, Professor, Department of Internal Medicine, Division of Hematology and Oncology, University of Missouri /Ellis Fischel Cancer Center
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: Bionumerik Consulting fee Consulting; Proactya Consulting fee Consulting; GSK Consulting fee Consulting; NovoNordisk Consulting fee Consulting; Amgen Honoraria Speaking and teaching; GSK Consulting fee Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

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.

CME Editor

Rajalaxmi McKenna, MD, FACP, Consulting Staff, Department of Medicine, Southwest Medical Consultants, SC, 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 at Tucson; 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; Amplimed Consulting fee Consulting

 
 
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