Mesothelioma Update

By Mark Block, MD; and Alice M. Boylan, MD

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Objectives

1. To be able to identify patients at risk for the development of malignant mesothelioma.
2. To understand how the diagnosis of malignant mesothelioma is made.
3. To understand the staging of malignant mesothelioma and important prognostic factors.
4. To understand the therapeutic options for patients with malignant mesothelioma.

Key words

asbestos; extrapleural pneumonectomy; mesothelioma; pleura; pleurectomy; pleurodesis

Abbreviations

EPP=extrapleural pneumonectomy; P/D=pleurectomy with decortication; PDT = photodynamic therapy

The incidence of malignant mesothelioma continues to increase in the United States and Europe, and by most recent estimates will continue to do so until 2020.¹ After that time, it is expected to continue to increase in other countries where the use of asbestos remains unregulated. Although a clear history of asbestos exposure is not always obtained, a history of heavy exposure makes the diagnosis more likely in a patient with a malignant pleural process. Cigarette smoking, however, does not place a patient at increased risk for the development of mesothelioma. Recently, there has been a great deal of controversy as to whether a simian virus that contaminated the polio vaccine administered from 1955 through 1961 may be contributing to the development of mesotheliomas in the United States and other countries. Although some laboratories have found evidence of this virus in tumor specimens, a recent multicenter evaluation of blinded specimens showed no evidence of this virus in specimens from 25 mesothelioma patients.² In addition, an epidemiologic impact has not yet been found.³

Because not all workers exposed to high amounts of asbestos develop mesothelioma, it is clear that unknown genetic factors increase the mesothelial cells’ susceptibility to asbestos. And although risk rises with the amount of exposure to asbestos and the fiber type, fiber numbers in the lung have not been shown to correlate with development of disease.⁴ Groups who have been associated with significant asbestos exposure and increased rates of mesotheliomas include workers in the asbestos industry, insulators, pipefitters, shipyard workers, brake mechanics, railroad workers, construction trades, household contacts of asbestos workers, and workers who perform maintenance and repair in buildings with asbestos insulation.⁵

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