Mesothelioma
Types of Mesothelioma
The most common site of mesothelioma is in the pleura, and this is what this module will focus on. Other sites include the peritoneum, pericardium, and tunica vaginalis.
Pleural Mesothelioma
Pleural Mesothelioma affects the thoracic pleura that lines the lungs, chest wall, diaphragm, and heart. It is the most common type, accounting for approximately 90% of mesothelioma cases. The median overall survival rate is 15 months with approximately 10% of patients surviving 5 years after diagnosis.1
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Peritoneal Mesothelioma
Accounts for approximately 10% of cases with a median survival rate of 1-5 years. It affects the peritoneum (lining of the abdominal cavity) and the membrane that covers the organs of the abdomen and pelvis, including the stomach, bowel, liver, kidneys, uterus and ovaries.2
Patients present with diffuse, extensive spread throughout the abdomen. Common symptoms may include:
- Swollen or painful abdomen
- Ascites
- Loss of appetite and weight loss
- Nausea/vomiting
- Constipation/Diarrhea
Due to the rarity of peritoneal mesothelioma and the non-specific symptoms that patients present with, it is usually diagnosed late when the disease burden is extensive.
Treatment includes:
- Systemic Chemotherapy and/or immunotherapy
- Cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS + HIPEC)
Cytoreductive surgery is a complex abdominal surgery that involves the stripping of the peritoneal lining. In addition, some patients may require organ resections if there is disease spread and or obstruction. Hyperthermic Intraperitoneal Chemotherapy involves the heating of chemotherapy drugs to 42–43 degrees Celsius which is continuously irrigated within the peritoneal cavity for 60–90 minutes intraoperatively.
Cytoreductive surgery is complex, and the patient requires a continual multidisciplinary approach to their care. Critical management of potential complications is imperative; they may include post-operative septic shock, anastomotic leaks, wound breakdown, and intra-abdominal collections.3
Pericardial Mesothelioma (membrane around the heart)
A median survival rate of 2 months.4
The symptoms are vague and may take many years to present. They may include:
- Chest pain
- Cardiac arrythmias
- Dyspnoea
- Right shoulder pain
- Swelling in lower extremities
Common clinical manifestations include constrictive pericarditis, cardiac tamponade, and heart failure.
Treatment includes:
- Systemic chemotherapy
- Pericardiectomy (tumour removal)
Unfortunately, due to the rarity and vague presentation of pericardial mesothelioma, most cases are diagnosed on autopsy after death.
Tunica Vaginalis Mesothelioma (membrane around the testes)
A median survival rate of 2 years.5
Symptoms include:
- Enlargement of the scrotum
- Hydrocele (abnormal fluid retention around the testicle)
- Paratesticular mass
Treatment includes:
- Chemotherapy
- Immunotherapy
- Radiation therapy
- Orchidectomy (removal of the testicle and spermatic cord).
References
- Musk AW, Olsen N, Alfonso H, et al. Predicting survival in malignant mesothelioma. European Respiratory Journal. 2011;38(6):1420-1424.
- Kim J, Bhagwandin S, Labow DM. Malignant peritoneal mesothelioma: A Review. Annals of Translational Medicine. 2017;5(11):236-236.
- García-Fadrique A, Mehta A, Mohamed F, Dayal S, Cecil T, Moran BJ. Clinical presentation, diagnosis, classification and management of Peritoneal Mesothelioma: A Review. Journal of Gastrointestinal Oncology. 2017;8(5):915-924.
- Godar M, Liu J, Zhang P, Xia Y, Yuan Q. Primary pericardial mesothelioma: a rare entity. Case Rep Oncol Med. 2013;2013:283601.
- Akin Y, Bassorgun I, Basara I, Yucel S. Malignant mesothelioma of tunica vaginalis: an extremely rare case presenting without risk factors. Singapore Med J. 2015;56(3):e53-e55.
