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Mesothelioma

Mesothelioma is an uncommon form of cancer, usually associated with previous exposure to asbestos. In this disease, malignant (cancerous) cells develop in the mesothelium, a protective lining that covers most of the body's internal organs. Its most common site is the pleura (outer lining of the lungs and chest cavity), but it may also occur in the peritoneum (the lining of the abdominal cavity) or the pericardium (a sac that surrounds the heart). more...

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Most people who develop mesothelioma have worked on jobs where they inhaled asbestos particles, or have been exposed to asbestos dust and fibre in other ways, such as by washing the clothes of a family member who worked with asbestos, or by home renovation using asbestos cement products.

Signs and symptoms

Symptoms of mesothelioma may not appear until 30 to 50 years after exposure to asbestos. Shortness of breath and pain in the chest due to an accumulation of fluid in the pleural space are often symptoms of pleural mesothelioma.

Symptoms of peritoneal mesothelioma include weight loss and cachexia, abdominal swelling and pain due to ascites (a buildup of fluid in the abdominal cavity). Other symptoms of peritoneal mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.

These symptoms may be caused by mesothelioma or by other, less serious conditions.

Diagnosis

Diagnosing mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient's medical history. A history of occupational exposure to asbestos may increase clinical suspicion for mesothelioma. A physical examination is performed, followed by chest X-ray and often lung function tests. The X-ray may reveal pleural thickening commonly seen after asbestos exposure and increases suspicion of mesothelioma. A CT (or CAT) scan or an MRI is usually performed. If a large amount of fluid is present, abnormal cells may be detected by cytology if this fluid is aspirated with a syringe. For pleural fluid this is done by a pleural tap or chest drain, in ascites with an paracentesis or ascitic drain and in a pericardial effusion with pericardiocentesis. While absence of malignant cells on cytology does not completely exclude mesothelioma, it makes it much more unlikely, especially if an alternative diagnosis can be made (e.g. tuberculosis, heart failure).

If cytology is positive or a plaque is regarded as suspicious, a biopsy is needed to confirm a diagnosis of mesothelioma. A doctor removes a sample of tissue for examination under a microscope by a histopathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples.

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Mesothelioma
From CHEST, 7/1/04 by Charles F. Thomas, Jr.

Mesothelioma By Bruce W. S. Robinson and A. Philippe Chahinian, eds. London: Taylor & Francis, A Martin Dunitz Book, 2002; 366 pp, $145.00

Malignant pleural mesothelioma is a disease of the industrialized age. Intimately associated with asbestos exposure, the incidence of this cancer has been steadily increasing worldwide. Treatment options for patients are not straightforward, and are best evaluated by a multidisciplinary team involving pulmonologists, thoracic surgeons, medical oncologists, radiation oncologists, and hospice-care practitioners. Unfortunately, no treatment has conclusively improved survival beyond supportive care. As such, many patients will require symptom palliation or end-of-life care. Given the association with asbestos, some patients or their families will explore litigation for compensation. To this complex scenario, the multiauthored book Mesothelioma contributes a comprehensive review of the history and epidemiology of mesothelioma, clinical material on diagnosis, pathophysiology and therapy, and medicolegal aspects of the disease.

A global perspective of the problem of mesothelioma is presented to the reader in several chapters of the book, and gives important insights into mesothelioma in Europe, Australia, Japan, South Africa, and the United States and Canada. The selection of international authors makes these sections of the book informative and interesting. Indeed, the thoroughly discussed material on the global epidemiology of this disease stands out as the strongest part of the book. The chapter on the medicolegal aspects of mesothelioma is highly relevant and very interesting; however, the discussion focuses on litigation history, and issues solely in Australia. A more global view of asbestos litigations in Europe, North America, Asia. and Africa would be of more general interest.

The overall organization of the book is somewhat haphazard, with chapters discussing the epidemiology of mesothelioma both at the beginning and end of the book. Likewise, the sections on pathology, molecular pathogenesis, and mechanistic insights into mesothelial cell reactions to asbestos fibers are not grouped together. Given that treatment options for many patients involve symptom palliation and hospice care, this section of the book is quite cursory, and an enhanced discussion of techniques for pain management would have made this chapter more informative. Although brief, the discussion of managing malignant effusion for symptomatic control is sufficient. Overall, the chapters discussing the diagnosis, pathophysiology, and therapy of pleural mesothelioma are thorough and well written. The chapter on radiographic imaging of mesothelioma, however, has images of chest radio graphs and CT scans that are not reproduced with adequate quality.

Mesothelioma is at comprehensive volume from recognized experts in dealing with this difficult disease. Although not without minor deficiencies, this hook should be of interest to those taking care of patients with mesothelioma, and would make a good addition to the library of professionals concerned with occupational lung diseases.

Charles F. Thomas, Jr, MD, FCCP Rochester, MN

COPYRIGHT 2004 American College of Chest Physicians
COPYRIGHT 2004 Gale Group

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