Malignant pleural mesothelioma: an update on investigation, diagnosis and treatment

Abstract

Malignant pleural mesothelioma is an aggressive malignancy of the pleural surface, predominantly caused by prior asbestos exposure. There is a global epidemic of malignant pleural mesothelioma underway, and incidence rates are predicted to peak in the next few years.This article summarises the epidemiology and pathogenesis of malignant pleural mesothelioma, before describing some key factors in the patient experience and outlining common symptoms. Diagnostic approaches are reviewed, including imaging techniques and the role of various biomarkers. Treatment options are summarised, including the importance of palliative care and methods of controlling pleural effusions. The evidence for chemotherapy, radiotherapy and surgery is reviewed, both in the palliative setting and in the context of trimodality treatment. An algorithm for managing malignant pleural effusion in malignant pleural mesothelioma patients is presented. Finally new treatment developments and novel therapeutic approaches are summarised.

Clinical diagnosis of malignant pleural mesothelioma

“…Further MPM progression may involve invasion of contralateral pleural cavity and peritoneum. Compared with lung cancer, distant metastases are usually rare since patients die before metastases occur (1,2).…”

“…They appear to have longer survival than symptomatic patients, probably because they are diagnosed earlier in the disease process (1). For this reason, it is important to carefully assess patients with a background of previous asbestos exposure who present with an unexplained pleural effusion.…”

“…Pleural-based mass lesions, pleural thickening >1 cm, nodular pleural thickening and diaphragmatic nodularity have a specificity of >95% with regard to malignancy but, as with chest X-ray the sensitivity is low at 40% and further investigations are needed if MPM is suspected (1,20).…”

“…It is associated with previous asbestos exposure; delayed onset of MPM following fibre exposure (up to 40 years) makes screening for the disease challenging (1). A slight increase in incidence has been observed over the last 10 years.…”

“…An estimate based on 2008 data suggested an average of 14,200 cases worldwide each year. Total incidence is highest in the United States and United Kingdom although, per capita, Australia and Italy also rank highly (1,2). Most patients present at diagnosis with advanced disease; prognosis is poor with a median survival ranging from 7 to 12 months with supportive care or chemotherapy, respectively (3).…”