Malignant mesothelioma

Our plain-English summary of Malignant mesothelioma, by A.J. Moore, R.J. Parker, J. Wiggins (Orphanet Journal of Rare Diseases, 2008).

The study

• Authors: A.J. Moore, R.J. Parker, J. Wiggins
• Journal: Orphanet Journal of Rare Diseases
• Published: 2008;3:34
• Type of article: Review
• Cited by: 99 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant mesothelioma is a fatal asbestos-associated malignancy originating from the lining cells (mesothelium) of the pleural and peritoneal cavities, as well as the pericardium and the tunica vaginalis. The exact prevalence is unknown but it is estimated that mesotheliomas represent less than 1% of all cancers. Its incidence is increasing, with an expected peak in the next 10-20 years. Pleural malignant mesothelioma is the most common form of mesothelioma. Typical presenting features are those of chest pain and dyspnoea. Breathlessness due to a pleural effusion without chest pain is reported in about 30% of patients. A chest wall mass, weight loss, sweating, abdominal pain and ascites (due to peritoneal involvement) are less common presentations. Mesothelioma is directly attributable to occupational asbestos exposure with a history of exposure in over 90% of cases. There is also evidence that mesothelioma may result from both para-occupational exposure and non-occupational "environmental" exposure. Idiopathic or spontaneous mesothelioma can also occur in the absence of any exposure to asbestos, with a spontaneous rate in humans of around one per million. A combination of accurate exposure history, along with examination radiology and pathology are essential to make the diagnosis. Distinguishing malignant from benign pleural disease can be challenging. The most helpful CT findings suggesting malignant pleural disease are 1) a circumferential pleural rind, 2) nodular pleural thickening, 3) pleural thickening of > 1 cm and 4) mediastinal pleural involvement. Involvement of a multidisciplinary team is recommended to ensure prompt and appropriate management, using a framework of radiotherapy, chemotherapy, surgery and symptom palliation with end of life care. Compensation issues must also be considered. Life expectancy in malignant mesothelioma is poor, with a median survival of about one year following diagnosis.

In plain English

This article was a review, not an original study. The authors summarised published research on malignant mesothelioma, a cancer of the lining of the pleural and peritoneal cavities, the pericardium and the tunica vaginalis. They collected no new patient data. Drawing on cited work, the review stated that the gap between asbestos exposure and disease can range from 15 to 60 years, that 70–80% of cases occur in men, and that a history of exposure is found in over 90% of cases. It cited epidemiologic data suggesting that crocidolite carries the highest mesothelioma risk and chrysotile the lowest. It noted that tremolite, often a contaminant of chrysotile, has been causally linked with increased risk. It also described para-occupational exposure, such as women laundering their husbands' overalls. The review covered diagnosis, staging and treatment with surgery, radiotherapy and chemotherapy, and cited median survival of 8 to 14 months. The authors recommended involving a multidisciplinary team. They wrote that cisplatin combined with an antifolate drug should be the reference chemotherapy regimen.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: narrative review of published literature (no original data)
• Who was studied: No study population; the review covered published research on malignant mesothelioma of the pleura, peritoneum, pericardium and tunica vaginalis
• Exposure: Asbestos in general (serpentine and amphibole fibres), with crocidolite described as highest risk and chrysotile as lowest per cited epidemiologic data. Also discussed: tremolite as a contaminant of chrysotile, erionite in parts of Turkey, para-occupational and environmental exposure, and SV-40
• Main results:
  • Citing other studies, the review stated that the latency between asbestos exposure and mesothelioma can range from 15 to 60 years
  • The review stated that mesothelioma is attributable to occupational asbestos exposure, with a history of exposure in over 90% of cases
  • The review stated that 70–80% of cases occur in men
  • Citing epidemiologic data, the review said crocidolite is associated with the highest mesothelioma risk and chrysotile with the lowest
  • The review noted that tremolite, often a contaminant of chrysotile asbestos, has been causally linked with increased mesothelioma risk
  • The review cited evidence that mesothelioma may result from para-occupational exposure, such as women laundering their husbands' overalls
  • Citing a recent review, the authors gave a spontaneous mesothelioma rate in humans of around one per million
  • The review cited median survival in malignant mesothelioma of between 8 and 14 months, and a mean survival of about 7 months for peritoneal mesothelioma
  • Citing a single trial of 331 patients, the review reported median survival of 13.3 months with pemetrexed/cisplatin compared with 10.0 months with cisplatin alone (p = 0.05)
• The authors' conclusion: The authors recommended involving a multidisciplinary team in management. They concluded that combination cisplatin and an antifolate should be the reference chemotherapy regimen in mesothelioma.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma, Mesothelium, Pericardium, Tunica Vaginalis, Pleural Effusion, Ascites, Asbestos Exposure, Take-home Exposure.

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